Provider Demographics
NPI:1295288819
Name:LOURDES HEALTH NETWORK
Entity type:Organization
Organization Name:LOURDES HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL SERVICES CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MNEDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:509-303-8422
Mailing Address - Street 1:207 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1009
Mailing Address - Country:US
Mailing Address - Phone:509-303-8422
Mailing Address - Fax:
Practice Address - Street 1:1175 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3300
Practice Address - Country:US
Practice Address - Phone:509-943-9104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602-813-810320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness