Provider Demographics
NPI:1689965063
Name:MISSION CREEK CORRECTIONS CENTER FOR WOMEN
Entity Type:Organization
Organization Name:MISSION CREEK CORRECTIONS CENTER FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-725-8301
Mailing Address - Street 1:PO BOX 41107
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-1107
Mailing Address - Country:US
Mailing Address - Phone:360-725-8298
Mailing Address - Fax:360-586-1320
Practice Address - Street 1:3420 NE SAND HILL RD
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-9007
Practice Address - Country:US
Practice Address - Phone:360-277-2400
Practice Address - Fax:360-277-2454
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF CORRECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health