Provider Demographics
NPI:1760056022
Name:CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
Entity Type:Organization
Organization Name:CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-634-2783
Mailing Address - Street 1:21 COLVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155-0150
Mailing Address - Country:US
Mailing Address - Phone:509-634-2783
Mailing Address - Fax:
Practice Address - Street 1:11614 HIGHWAY 21 SOUTH
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:WA
Practice Address - Zip Code:99140
Practice Address - Country:US
Practice Address - Phone:509-634-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility