Provider Demographics
NPI:1992859078
Name:OUR LADY OF LOURDES AT PASCO
Entity Type:Organization
Organization Name:OUR LADY OF LOURDES AT PASCO
Other - Org Name:LOURDES WILSON HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:FOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-543-2483
Mailing Address - Street 1:224 N 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5411
Mailing Address - Country:US
Mailing Address - Phone:509-545-3390
Mailing Address - Fax:509-543-2488
Practice Address - Street 1:224 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5411
Practice Address - Country:US
Practice Address - Phone:509-545-3390
Practice Address - Fax:509-543-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTIN