NPIMap

Organization Active NPI

Rainier State School

  • Intellectual Disabilities Intermediate Care Facility
  • Buckley, WA
National Provider Identifier
1164547626
Registry record updated Jan 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
RAINIER STATE SCHOOL
Practice address
2120 Ryan Rd
Buckley, WA 98321-9115
Phone
(360) 829-1111
Fax
(360) 829-3088
NPI assigned
Mar 20, 2007
Last updated
Jan 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2023

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

Authorized official

Name
Colleen T Peck, MDNPI 1831775980
Title
Medical Director
Phone
(425) 301-9856

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X

Addresses

Primary practice location

2120 Ryan Rd
Buckley, WA 98321-9115

Mailing address

2120 Ryan Rd
Buckley, WA 98321-9115
Phone (360) 829-1111

National Provider Directory

National Provider Directory
Tax ID family
Rainier School Pharmacy2 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.

Locations

2120 Ryan Rd
Buckley, WA 98321
Phone (360) 829-1111

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672704000000",
    "number": "1164547626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 RYAN RD",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983219115",
            "telephone_number": "360-829-1111",
            "fax_number": "360-829-3088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 RYAN RD",
            "city": "BUCKLEY",
            "state": "WA",
            "postal_code": "983219115",
            "telephone_number": "360-829-1111",
            "fax_number": "360-829-3088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAINIER STATE SCHOOL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2023-01-03",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "425-301-9856",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buckley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2023; 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.