Provider Demographics
NPI:1811954373
Name:SPOKANE REGIONAL HEALTH DISTRICT
Entity type:Organization
Organization Name:SPOKANE REGIONAL HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-324-1660
Mailing Address - Street 1:1101 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2029
Mailing Address - Country:US
Mailing Address - Phone:509-324-1660
Mailing Address - Fax:509-324-3609
Practice Address - Street 1:1101 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2029
Practice Address - Country:US
Practice Address - Phone:509-324-1660
Practice Address - Fax:509-324-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 261QM2800X, 261QR0405X, 251K00000X
WA50D0672084291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991173Medicaid
600001762OtherMEDICARE RAILROAD
WA0117197OtherLABOR & INDUSTRIES
WA101962700Medicaid
WA7043045Medicaid
WA7138670Medicaid
WAG000312380OtherMEDICARE GROUP PIN
WA00031369Medicaid
WA7403405Medicaid
WA7403546Medicaid
WA7403405Medicaid
WA00031369Medicaid
WA1991173Medicaid