Provider Demographics
NPI:1891097812
Name:CANCER SUPPORT SERVICES OF BATTLE GROUND, INC.
Entity Type:Organization
Organization Name:CANCER SUPPORT SERVICES OF BATTLE GROUND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, OCN
Authorized Official - Phone:360-977-3501
Mailing Address - Street 1:2908 NW 3RD CIR
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2908 NW 3RD CIR
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-4334
Practice Address - Country:US
Practice Address - Phone:360-977-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60044395251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health