Provider Demographics
NPI:1487236147
Name:SNOQUALMIE INC
Entity type:Organization
Organization Name:SNOQUALMIE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-413-0852
Mailing Address - Street 1:50 W BROADWAY STE 333
Mailing Address - Street 2:PMB 14624
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2027
Mailing Address - Country:US
Mailing Address - Phone:855-492-5787
Mailing Address - Fax:
Practice Address - Street 1:50 W BROADWAY STE 333
Practice Address - Street 2:PMB 14624
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2027
Practice Address - Country:US
Practice Address - Phone:855-492-5787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management