Provider Demographics
NPI:1205441235
Name:ANSIL A NEW START IN LIFE
Entity type:Organization
Organization Name:ANSIL A NEW START IN LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-200-2469
Mailing Address - Street 1:2625 W BRUNEAU PL # 136
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3168
Mailing Address - Country:US
Mailing Address - Phone:509-628-4047
Mailing Address - Fax:
Practice Address - Street 1:2625 W BRUNEAU PL # 136
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3168
Practice Address - Country:US
Practice Address - Phone:509-628-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604355700OtherUBI