Provider Demographics
NPI:1649712449
Name:YAKIMA SPECIALTIES, INC
Entity type:Organization
Organization Name:YAKIMA SPECIALTIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-453-0386
Mailing Address - Street 1:1819 W J ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-1227
Mailing Address - Country:US
Mailing Address - Phone:509-453-0386
Mailing Address - Fax:509-453-1279
Practice Address - Street 1:1819 W J ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-1227
Practice Address - Country:US
Practice Address - Phone:509-453-0386
Practice Address - Fax:509-453-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA397-018-990251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services