Provider Demographics
NPI:1124860283
Name:QUINAULT INDIAN NATION
Entity type:Organization
Organization Name:QUINAULT INDIAN NATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:G
Authorized Official - Last Name:HALSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:564-544-1930
Mailing Address - Street 1:511 W HERON ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6022
Mailing Address - Country:US
Mailing Address - Phone:564-544-1950
Mailing Address - Fax:564-544-1928
Practice Address - Street 1:511 W HERON ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6022
Practice Address - Country:US
Practice Address - Phone:564-544-1950
Practice Address - Fax:564-544-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health