Provider Demographics
NPI:1134238983
Name:TOWN OF CRESTON
Entity type:Organization
Organization Name:TOWN OF CRESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-636-3145
Mailing Address - Street 1:PO BOX 3510
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3510
Mailing Address - Country:US
Mailing Address - Phone:360-394-7010
Mailing Address - Fax:360-394-7099
Practice Address - Street 1:SE 100 CRESTON AVE
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:WA
Practice Address - Zip Code:99117
Practice Address - Country:US
Practice Address - Phone:509-636-3145
Practice Address - Fax:509-636-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA22M023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000301624Medicare PIN