Provider Demographics
NPI:1952603532
Name:RED MOUNTAIN FIELD CASE MANAGEMENT LLC
Entity type:Organization
Organization Name:RED MOUNTAIN FIELD CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RN CERTIFIED CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TABER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCM
Authorized Official - Phone:509-851-8707
Mailing Address - Street 1:51621 DEMOSS RD
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320
Mailing Address - Country:US
Mailing Address - Phone:509-851-8707
Mailing Address - Fax:509-588-3532
Practice Address - Street 1:51621 DEMOSS RD
Practice Address - Street 2:
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320
Practice Address - Country:US
Practice Address - Phone:509-851-8707
Practice Address - Fax:509-588-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00090060163WC0400X, 251B00000X
WARN00110622171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0263853OtherDEPT OF LABOR INDUSTRIES