Provider Demographics
NPI:1679167944
Name:MADDIE'S PLACE
Entity Type:Organization
Organization Name:MADDIE'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-315-5146
Mailing Address - Street 1:1004 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2431
Mailing Address - Country:US
Mailing Address - Phone:509-315-5146
Mailing Address - Fax:
Practice Address - Street 1:1004 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2431
Practice Address - Country:US
Practice Address - Phone:509-315-5146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric