Provider Demographics
NPI:1710283619
Name:YAKIMA VALLEY COUNCIL ON ALCOHOLISM
Entity Type:Organization
Organization Name:YAKIMA VALLEY COUNCIL ON ALCOHOLISM
Other - Org Name:TRIUMPH TREATMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-853-4121
Mailing Address - Street 1:PO BOX 2849
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2849
Mailing Address - Country:US
Mailing Address - Phone:509-248-1800
Mailing Address - Fax:509-576-3076
Practice Address - Street 1:608 SUPERIOR LANE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1623
Practice Address - Country:US
Practice Address - Phone:509-853-4175
Practice Address - Fax:509-576-3050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAKIMA VALLEY COUNCIL ON ALCOHOLISM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-10
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600393849261QM3000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA152200Medicaid