NPIMap

Organization Active NPI

Northwest Indian Treatment Center

  • Clinic/Center
  • Shelton, WA
National Provider Identifier
1215063169
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
23037400 Issued in WA
Legal business name
NORTHWEST INDIAN TREATMENT CENTER
Practice address
100 SE Whitener Rd
Shelton, WA 98584-7747
Phone
(360) 470-1474
NPI assigned
Feb 26, 2007
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
June O'Brien
Title
Director
Phone
(360) 470-1474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 23037400 WA Primary

Addresses

Primary practice location

100 SE Whitener Rd
Shelton, WA 98584-7747

Mailing address

308 E. Young St.
Box 477
Elma, WA 98541

Other identifiers 1

IdentifierTypeStateIssuer
1990696MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Squaxin Island Tribe11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

100 SE Whitener Rd
Shelton, WA 98584
Phone (360) 426-1582

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215063169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 E. YOUNG ST.",
            "address_2": "BOX 477",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "98541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SE WHITENER RD",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985847747",
            "telephone_number": "360-470-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST INDIAN TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "JUNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "360-470-1474"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "23037400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1990696",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, 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.