Provider Demographics
NPI:1912606203
Name:SEVENTY X 7 SUPPORT SERVICE
Entity Type:Organization
Organization Name:SEVENTY X 7 SUPPORT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ALMANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-439-9660
Mailing Address - Street 1:1841 GAP RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:WA
Mailing Address - Zip Code:98932-9487
Mailing Address - Country:US
Mailing Address - Phone:509-439-9660
Mailing Address - Fax:
Practice Address - Street 1:164 GALILEE LN
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:WA
Practice Address - Zip Code:98932-6002
Practice Address - Country:US
Practice Address - Phone:509-439-9660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services