NPIMap

Organization Active NPI

Nooksack Central Management System

Doing business as Nooksack Cabin Creek Youth Program

  • Addiction (Substance Use Disorder) Counselor
  • Easton, WA
National Provider Identifier
1063739738
Registry record updated Apr 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Legal business name
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Doing business as
Nooksack Cabin Creek Youth Program
Practice address
3003 Cabin Creek Road
Easton, WA 98925
Phone
(425) 508-3967
NPI assigned
Apr 21, 2010
Organization subpart
Yes
Parent organization
NOOKSACK TRIBES GENESIS IIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2010

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

Authorized official

Name
Mr. Kevin Collins, CCDCII, CHT
Title
Director of Treatment Services
Phone
(360) 966-7704

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X Primary

Addresses

Primary practice location

3003 Cabin Creek Road
Easton, WA 98925

Mailing address

PO Box 157
Deming, WA 98244-0157
Phone (360) 966-7704

Other identifiers 1

IdentifierTypeStateIssuer
1993013MedicaidWA

Other names 1

  • Nooksack Cabin Creek Youth Program Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Nooksack Indian Tribe8 organizations share this tax ID, including this one
Part of
Nooksack Indian Tribe

Other organizations with this tax ID 7

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271808000000",
    "number": "1063739738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157",
            "city": "DEMING",
            "state": "WA",
            "postal_code": "982440157",
            "telephone_number": "360-966-7704",
            "fax_number": "360-966-4225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 CABIN CREEK ROAD",
            "city": "EASTON",
            "state": "WA",
            "postal_code": "98925",
            "telephone_number": "425-508-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOOKSACK CENTRAL MANAGEMENT SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NOOKSACK TRIBES GENESIS II",
        "enumeration_date": "2010-04-21",
        "last_updated": "2010-04-21",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "DIRECTOR OF TREATMENT SERVICES",
        "authorized_official_telephone_number": "360-966-7704",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CCDCII, CHT"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1993013",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nooksack Cabin Creek Youth Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Easton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; 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.