Basic Information
| Provider Information | |||||||||
| NPI: | 1295851160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOWER ELWHA KLALLAM TRIBE | ||||||||
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| OtherOrganizationName: | LOWER ELWHA HEALTH & HUMAN SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3080 LOWER ELWHA RD | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983638411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604528471 | ||||||||
| FaxNumber: | 3604578429 | ||||||||
| Practice Location | |||||||||
| Address1: | 3080 LOWER ELWHA RD | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983638411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604528471 | ||||||||
| FaxNumber: | 3604578429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHARLES | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRWOMAN | ||||||||
| AuthorizedOfficialTelephone: | 3604528471 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.