NPIMap

Organization Active NPI

Washington Odd Fellows Home

  • Assisted Living Facility
  • Walla Walla, WA
National Provider Identifier
1114917630
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
BH125 Issued in WA
Legal business name
WASHINGTON ODD FELLOWS HOME
Practice address
534 Boyer Ave
Walla Walla, WA 99362-2047
Phone
(509) 525-6463
Fax
(509) 522-0578
NPI assigned
Oct 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
John R Brigham
Title
Administrator
Phone
(509) 525-6463

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X BH125 WA Primary

Addresses

Primary practice location

534 Boyer Ave
Walla Walla, WA 99362-2047

Mailing address

534 Boyer Ave
Walla Walla, WA 99362-2047
Phone (509) 525-6463

Other identifiers 1

IdentifierTypeStateIssuer
129082MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Odd Fellows Home of Wa2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114917630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "534 BOYER AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622047",
            "telephone_number": "509-525-6463",
            "fax_number": "509-522-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 BOYER AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622047",
            "telephone_number": "509-525-6463",
            "fax_number": "509-522-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHINGTON ODD FELLOWS HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRIGHAM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-525-6463"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WA",
            "license": "BH125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "129082",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

  • 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.