Provider Demographics
NPI:1710175724
Name:YAKIMA INDIAN NATION
Entity Type:Organization
Organization Name:YAKIMA INDIAN NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CORDANATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:509-874-2979
Mailing Address - Street 1:520 SIGNAL PEAK ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITE SWAN
Mailing Address - State:WA
Mailing Address - Zip Code:98952
Mailing Address - Country:US
Mailing Address - Phone:509-874-2979
Mailing Address - Fax:509-874-2113
Practice Address - Street 1:520 SIGNAL PEAK ROAD
Practice Address - Street 2:
Practice Address - City:WHITE SWAN
Practice Address - State:WA
Practice Address - Zip Code:98952-0693
Practice Address - Country:US
Practice Address - Phone:509-874-2979
Practice Address - Fax:509-874-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10002016261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service