NPIMap

Organization Active NPI

Confederated Tribes of the Colville Reservation

Doing business as Colville Tribal Convalescent Center

  • Skilled Nursing Facility
  • Nespelem, WA
National Provider Identifier
1952429862
Registry record updated Jun 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
N764 Issued in WA
Legal business name
CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
Doing business as
Colville Tribal Convalescent Center
Practice address
29 Convalescent Center Blvd.
Nespelem, WA 99155-0150
Phone
(509) 634-2877
Fax
(509) 634-2889
NPI assigned
Mar 27, 2007
Last updated
Jun 4, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CONFEDERATED TRIBES OF THE COLVILLE RESERVATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2026

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

Authorized official

Name
Glenda Jo Whitelaw, RHIT
Title
Office Manager
Phone
(509) 634-2877

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X N764 WA Primary

Addresses

Primary practice location

29 Convalescent Center Blvd.
Nespelem, WA 99155-0150

Mailing address

PO Box 150
Nespelem, WA 99155-0150
Phone (509) 634-2877

Other identifiers 1

IdentifierTypeStateIssuer
4176400MedicaidWA

Other names 1

  • Colville Tribal Convalescent Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150217002278 WA Part A Provider - Skilled Nursing Facility 1254332505 Practice locations: Nespelem, WA
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952429862. Details of each certification follow.

Skilled nursing facility certification: CCN 505412

Legal name
CONFEDERATED TRIBES OF THE COLVILLE RESERVATION
Doing business as
COLVILLE TRIBAL CONVALESCENT CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1992
Last certification
Apr 3, 2025
Beds
44
Ownership / control type
Federal
Organization structure
GovernmentNon-profit
Incorporated
Nov 5, 1981 in WA
Enrollment address
29 Convalescent Center Blvd
Nespelem, WA 99155
Nursing home name
COLVILLE TRIBAL CONVALESCENT C

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Colville Tribal Convalescent CCCN 505412 · All quality measures
Overall star rating
3 of 5
Health inspections
4 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - Federal
Certified
Jan 1, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4432.7 residents per day on average
Penalties (3 years)
1Fines totaling $8,173

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Confederated Tribes of the Colville Reservation16 organizations share this tax ID, including this one
Part of
Confederated Tribes of the Colville Reservation

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Loren L Lewis Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024
Confederated Tribes of the Colville Reservation Organization, Nespelem, WA 5% Or Greater Direct Ownership Interest Nov 5, 1981 100%
Adp of the SNF Nov 5, 1981
Jarred-Michael Erickson Individual Operational/Managerial Control Jan 1, 2024
Managing Control - Governing BodyColville Tribes Business Chairman Jan 1, 2024
Adp of the SNF Jan 1, 2024
Casey Moore Individual Operational/Managerial Control Jan 1, 2024
Managing Control - Governing BodyHealth and Human Services Director Jan 1, 2024
Adp of the SNF Jan 1, 2024
Sally Hutton Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake Roosevelt Community Health CentersInchelium, WA, CCN 501902 Federally qualified health center 5% Or Greater Direct Ownership Interest Jun 2, 2017

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780531200000",
    "number": "1952429862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "NESPELEM",
            "state": "WA",
            "postal_code": "991550150",
            "telephone_number": "509-634-2877",
            "fax_number": "509-634-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 CONVALESCENT CENTER BLVD.",
            "city": "NESPELEM",
            "state": "WA",
            "postal_code": "991550150",
            "telephone_number": "509-634-2877",
            "fax_number": "509-634-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONFEDERATED TRIBES OF THE COLVILLE RESERVATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONFEDERATED TRIBES OF THE COLVILLE RESERVATION",
        "enumeration_date": "2007-03-27",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A",
        "authorized_official_last_name": "WHITELAW",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "509-634-2877",
        "authorized_official_credential": "RHIT"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "N764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4176400",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colville Tribal Convalescent Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nespelem, WA

Sources for this page

Verify at the official NPI Registry.