Provider Demographics
NPI:1114239449
Name:CATHOLIC CHARITIES OF THE DIOCESE OF YAKIMA
Entity type:Organization
Organization Name:CATHOLIC CHARITIES OF THE DIOCESE OF YAKIMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDENBORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-946-4645
Mailing Address - Street 1:2139 VAN GIESEN ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2746
Mailing Address - Country:US
Mailing Address - Phone:509-946-4645
Mailing Address - Fax:509-943-2068
Practice Address - Street 1:2139 VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-2746
Practice Address - Country:US
Practice Address - Phone:509-946-4645
Practice Address - Fax:509-943-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7407554Medicaid