Provider Demographics
NPI:1922515519
Name:ENTRUST COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ENTRUST COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAULKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-834-1220
Mailing Address - Street 1:PO BOX 9727
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98909-0727
Mailing Address - Country:US
Mailing Address - Phone:509-834-1220
Mailing Address - Fax:
Practice Address - Street 1:213 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3220
Practice Address - Country:US
Practice Address - Phone:509-834-1220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093418Medicaid