Port Gamble S'Klallam Orca Pride

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

PORT GAMBLE S'KLALLAM ORCA PRIDE

Practice address

32014 Little Boston Rd NE
Kingston, WA 98346-9734

Phone

(360) 297-9601

Fax

(360) 297-9614

NPI assigned

Apr 17, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kerstin Margareta Powell

Title

Health Center Business Office Manag

Phone

(360) 297-9601

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Port Gamble S'Klallam Tribe7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

• Port Gamble S'Klallam Chemical Dependency Program

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Kingston, WA
  • NPI 1578622973
  NPD tax ID
• Port Gamble S'Klallam Dental Clinic

  • Dental Clinic/Center
  • Kingston, WA
  • NPI 1669531067
  NPD tax ID
• Port Gamble S'Klallam Mental Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kingston, WA
  • NPI 1154480051
  NPD tax ID
• Port Gamble S'Klallam Social Services

  • Adolescent and Children Mental Health Clinic/Center
  • Kingston, WA
  • NPI 1649391871
  NPD tax ID
• Port Gamble S'Klallam Tribe

  • Federally Qualified Health Center (FQHC)
  • Kingston, WA
  • NPI 1518585579
  NPD tax ID
• Port Gamble S'Klallam Tribe

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Kingston, WA
  • NPI 1922970458
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043435563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32014 LITTLE BOSTON RD NE",
            "city": "KINGSTON",
            "state": "WA",
            "postal_code": "983469734",
            "telephone_number": "360-297-9601",
            "fax_number": "360-297-9614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32014 LITTLE BOSTON RD NE",
            "city": "KINGSTON",
            "state": "WA",
            "postal_code": "983469734",
            "telephone_number": "360-297-9601",
            "fax_number": "360-297-9614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT GAMBLE S'KLALLAM ORCA PRIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "KERSTIN",
        "authorized_official_middle_name": "MARGARETA",
        "authorized_official_title_or_position": "HEALTH CENTER BUSINESS OFFICE MANAG",
        "authorized_official_telephone_number": "360-297-9601"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1994623",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ricky L Penney, LMP
• Frank V Peters, D.D.S.
• Port Gamble S'Klallam Chemical Dependency Program
• Port Gamble S'Klallam Dental Clinic
• Port Gamble S'Klallam Mental Health
• Port Gamble S'Klallam Social Services
• Port Gamble S'Klallam Tribe
• Port Gamble S'Klallam Tribe
• Port Gamble S'Klallam Tribe
• Dian Aletha Poyssick, RPH

• All providers in Kingston, WA
• Substance Use Disorder Rehabilitation Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.