Provider Demographics
NPI:1700475886
Name:LOURDES CULLUM HOUSE
Entity Type:Organization
Organization Name:LOURDES CULLUM HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENTIAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-761-2081
Mailing Address - Street 1:3523 W HOOD AVE APT A104
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2782
Mailing Address - Country:US
Mailing Address - Phone:509-761-2081
Mailing Address - Fax:
Practice Address - Street 1:208 CULLUM AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4534
Practice Address - Country:US
Practice Address - Phone:509-947-6055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities