Provider Demographics
NPI:1760596571
Name:STATE OF WASH - STATE SCHOOL FOR THE BLIND
Entity Type:Organization
Organization Name:STATE OF WASH - STATE SCHOOL FOR THE BLIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-696-6321
Mailing Address - Street 1:2214 EAST 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:360-696-6321
Mailing Address - Fax:360-737-2120
Practice Address - Street 1:2214 EAST 13TH STREET
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-696-6321
Practice Address - Fax:360-737-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7440399Medicaid