Confederated Tribes of the Colville Reservation
Organization Active NPI Substance Abuse Rehabilitation Facility · Keller, WA
NPI 1760056022 · NPPES record last updated Jun 4, 2026
Key facts
- NPI
- 1760056022
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
- Practice address
- 11614 Highway 21 South
Keller, WA 99140 - Phone
- (509) 634-2050
- NPI assigned
- May 19, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
Authorized official
- Name
- Amy Church
- Title
- Revenue Cycle Manager
- Phone
- (509) 634-2783
Other NPIs on the same Medicare enrollment 6
Corporate family (same tax ID) 15
Practitioners 3
-
Jadi Jo Reynolds, LAC
-
Rhonda Lynn Friedlander, M.S.CCC-SLP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220125000740 | TX | Part B Supplier - Clinic/Group Practice | 1254332505 |
Receives reassigned benefits from 2 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Inchelium, WA; Omak, WA; Nespelem, WA; Keller, WA |
National Provider Directory
- Tax ID family
- Confederated Tribes of the Colville Reservation
- Part of
- Confederated Tribes of the Colville Reservation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
11614 Highway 21 South
Keller, WA 99140
Mailing address
PO Box 150
Nespelem, WA 99155-0150
Phone (509) 634-2783
Other names
- San Poil Treatment Center
Other providers in Keller, WA
- Hope E Achenbach
- Clara Ann Carson
- Colville Nation Community Health Centers
- Confederated Tribes of the Colville Reservation
- Sheri Gray
- Keller School District
- Jadi Jo Reynolds
All providers in Keller, WA · Substance Abuse Rehabilitation Facility in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.