Provider Demographics
NPI:1487148789
Name:OUR PLACE MULTICULTURAL COMMUNITY CENTER
Entity type:Organization
Organization Name:OUR PLACE MULTICULTURAL COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME CARE AIDE
Authorized Official - Prefix:
Authorized Official - First Name:OPHELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:HOME CARE AIDE
Authorized Official - Phone:360-635-5235
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-0031
Mailing Address - Country:US
Mailing Address - Phone:360-635-5235
Mailing Address - Fax:
Practice Address - Street 1:3108 FIR ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1939
Practice Address - Country:US
Practice Address - Phone:360-449-2567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NOBLE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 332U00000X, 343900000X
WA60440919253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)