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Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Parent organization
NOOKSACK CENTRAL MANAGMENT SYSTEM
Other names
The Nooksack Hope Behavioral Health Program
Organization subpart
Yes
Provider details
NPI number
Legal business name
NOOKSACK CENTRAL MANAGMENT SYSTEM
Authorized official
ERIC R DAVENPORT (GOVERNMENTAL SERVICE EXECUTIVE)
(360) 592-5176
Entity
Organization
Contact information
Practice address
6760 MISSION RD, EVERSON, WA 98247-9749
(360) 966-4150
(360) 966-4111
Mailing address
PO BOX 157, DEMING, WA 98244-0157
(360) 966-4150
(360) 966-4111
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1981018
—
WA
Enumeration date
05/14/2007
Last updated
10/03/2011
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