Organization
WASHINGTON ODD FELLOWS HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R BRIGHAM (ADMINISTRATOR)
(509) 525-6463
Entity
Organization
Contact information
Practice address
534 BOYER AVE, WALLA WALLA, WA 99362-2047
(509) 525-6463
(509) 522-0578
Mailing address
534 BOYER AVE, WALLA WALLA, WA 99362-2047
(509) 525-6463
(509) 522-0578
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
BH125
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129082
—
WA
Enumeration date
10/26/2005
Last updated
08/22/2020
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