# WASHINGTON ODD FELLOWS HOME

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639169097
- **Authorized official:** JOHN R BRIGHAM (ADMINISTRATOR)
- **Authorized official phone:** (509) 525-6463

## Contact information

- **Practice address:** 534 BOYER AVENUE, WALLA WALLA, WA 99362
- **Practice address phone:** (509) 525-6463
- **Practice address fax:** (509) 526-6883
- **Mailing address:** 534 BOYER AVENUE, WALLA WALLA, WA 99362
- **Mailing address phone:** (509) 525-6463
- **Mailing address fax:** (509) 526-6883

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH351 | WA | Yes |

## Other

- **Enumeration date:** 10/26/2005
- **Last updated:** 02/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1015156 | — | WA |
| 05 | — | 4135109 | — | WA |