Provider Demographics
NPI:1689650756
Name:TEKOA MEDICAL FOUNDATION INC
Entity Type:Organization
Organization Name:TEKOA MEDICAL FOUNDATION INC
Other - Org Name:TEKOA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN NHA
Authorized Official - Phone:509-284-4501
Mailing Address - Street 1:330 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TEKOA
Mailing Address - State:WA
Mailing Address - Zip Code:99033-9772
Mailing Address - Country:US
Mailing Address - Phone:509-284-4501
Mailing Address - Fax:509-286-3737
Practice Address - Street 1:330 N MADISON ST
Practice Address - Street 2:
Practice Address - City:TEKOA
Practice Address - State:WA
Practice Address - Zip Code:99033-9772
Practice Address - Country:US
Practice Address - Phone:509-284-4501
Practice Address - Fax:509-286-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANH597313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4159703Medicaid
WA4159703Medicaid