Jamestown S'Klallam Tribe
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Sequim, WA
NPI 1104901941 · NPPES record last updated Apr 15, 2026
Key facts
- NPI
- 1104901941
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- JAMESTOWN S'KLALLAM TRIBE
- Practice address
- 526 S 9TH Ave
Sequim, WA 98382-3626 - Phone
- (360) 681-7755
- Fax
- (360) 681-5999
- NPI assigned
- Oct 26, 2006
- Organization subpart
- No
Authorized official
- Name
- W. Ron Allen
- Title
- Tribal Chairman/Executive Director
- Phone
- (360) 683-1109
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 5
Practitioners 40
-
Karen M Carlson, ARNP
-
Jess Calohan, DNP, PMHNP-BC, FAAN
-
Tarran Chambers, ARNP
-
Risa Denenberg, ARNP
-
Andrea Ann Eickelmann, DNP, ARNP, FNP-C
-
James Alfred Fasciano, M.D.
-
Maia R Gala, MS, PA-C
-
Nicholas Joseph Grinnell, PA-C
-
April C. Grisetti, PA-C
-
Josh Huhndorf, MD
-
Stephanie Kloth, PAC
-
Donald C Manuele, DO
-
Jerome R Oakes, M.D.
-
Pamela Lynne Payne, ARNP
-
Phillip Luther Shealy, ARNP, FNP
-
Dean Short, PA-C
-
Connie M Walker, P.A.-C.
-
Robert Anthony Welch, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
- Opioid treatment program
- Medicare-enrolled since Oct 15, 2022
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Jamestown Family Health Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 17, 2010 |
| Jamestown Healing Clinic |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | May 17, 2010 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050507000057 | WA | Part B Supplier - Clinic/Group Practice | 2365349495 |
Receives reassigned benefits from 45 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sequim, WA |
| O20230315002073 | WA | Part B Supplier - Opioid Treatment Program (Otp) | 2365349495 | Practice locations: Sequim, WA |
National Provider Directory
- Tax ID family
- Jamestown Sklallam Trib
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | |||
| Methadone Clinic | 261QM2800X | |||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
526 S 9TH Ave
Sequim, WA 98382-3626
Mailing address
526 S 9TH Ave
Sequim, WA 98382-3626
Phone (360) 681-7755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1981141 | Medicaid | WA |
Other names
- Jamestown Healing Clinic
Other providers in Sequim, WA
- Lauren Jackson
- Frank Henry Jahns
- Harry Charles James
- Jamestown S'Klallam Tribe
- Jamestown S'Klallam Tribe
- Jamestown S'Klallam Tribe
- Jamestown S'Klallam Tribe
- Jamestown S'Klallam Tribe
- Jamestown S'Klallam Tribe
- Jamestown S'Klallam Tribe
All providers in Sequim, WA · Substance Use Disorder Rehabilitation Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.