WALLA WALLA COUNTY (WALLA WALLA COUNTY DEPARTMENT OF HUMAN SERVICES) - NPI NUMBER 1972687374

Summary

Provider Name: WALLA WALLA COUNTY (WALLA WALLA COUNTY DEPARTMENT OF HUMAN SERVICES)

NPI Number: 1972687374

Clasification: Community/Behavioral Health (251S00000X)

Address:
1520 KELLEY PL
SUITE 220
WALLA WALLA, WA
ZIP 99362

Phone Number: (509) 524-2920



Detailed Information

WALLA WALLA COUNTY is a community/behavioral health in Walla Walla, WA. The provider is a private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. The assigned NPI number for this provider is 1972687374 and is registered as an organization entity type.
The provider Is Doing Business As Walla Walla County Department Of Human Services.

The provider's business address is:

1520 KELLEY PL
SUITE 220
WALLA WALLA, WA
ZIP 99362-654
Phone: (509) 524-2920
Fax: (509) 524-2993

The provider's authorized official is Harvey R Crowder .
The authorized official title is Interim Director and has the following contact phone number (509) 524-2920.

The enumeration date for this NPI number is 10/24/2006 and was last updated on 1/4/2013.

Map - Location of Practice

Similar Providers

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1083859722 TEAMING FOR SUCCESS
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1508056847 COUNTY OF WALLA WALLA
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1609287820 CENTRAL WASHINGTON COMPREHENSIVE MENTAL HEALTH
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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 251S00000X Community/Behavioral Health WA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 251B00000SX MEDICAID WA
2 8853859 MEDICARE PIN WA
3 251S00000X MEDICAID WA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1972687374 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name WALLA WALLA COUNTY The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name WALLA WALLA COUNTY DEPARTMENT OF HUMAN SERVICES Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 1520 KELLEY PL The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE 220 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name WALLA WALLA The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name WA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 993628654 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 5095242920 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 5095242993 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 10/24/2006 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 1/4/2013 The date that a record was last updated or changed.
17 Authorized Official Last Name CROWDER The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name HARVEY The first name of the authorized official.
19 Authorized Official Middle Name R The middle name of the authorized official.
20 Authorized Official Title or Position INTERIM DIRECTOR The title or position of the authorized official.
21 Authorized Official Telephone Number 5095242920 The 10-position telephone number of the authorized official.
22 Healthcare Provider Taxonomy Code 1 251S00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
23 Provider License Number State Code 1 WA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Other Provider Identifier 1 251B00000SX Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier State 1 WA
28 Other Provider Identifier 2 8853859 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier Type Code 2 08 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier State 2 WA
31 Other Provider Identifier 3 251S00000X Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
32 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier State 3 WA
34 Is Organization Subpart N
35 Authorized Official Name Prefix Text DR.
36 Authorized Official Credential Text DVM, MS, DACVPM

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This page was last updated on: 2/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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