Provider Demographics
NPI:1952506420
Name:STAFFORD CREEK CORRECTION CENTER
Entity Type:Organization
Organization Name:STAFFORD CREEK CORRECTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, HEALTH SERVICES DOC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:F
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-725-8700
Mailing Address - Street 1:191 CONSTANTINE WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-9504
Mailing Address - Country:US
Mailing Address - Phone:360-537-2167
Mailing Address - Fax:360-537-2075
Practice Address - Street 1:191 CONSTANTINE WAY
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-9504
Practice Address - Country:US
Practice Address - Phone:360-537-2167
Practice Address - Fax:360-537-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered251K00000XAgenciesPublic Health or Welfare
Not Answered311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty