Provider Demographics
NPI:1710182787
Name:SWINOMISH HEALTH SERVICES
Entity Type:Organization
Organization Name:SWINOMISH HEALTH SERVICES
Other - Org Name:SWINOMISH WELLNESS PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-588-2800
Mailing Address - Street 1:8212 S. MARCH POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-8684
Mailing Address - Country:US
Mailing Address - Phone:360-588-2800
Mailing Address - Fax:360-588-2808
Practice Address - Street 1:17337 RESERVATION ROAD
Practice Address - Street 2:
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-8802
Practice Address - Country:US
Practice Address - Phone:360-466-1024
Practice Address - Fax:360-466-7364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002083324500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2169281Medicaid