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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MOYA J NEAL (INCORPORATOR/TREASURER)
(509) 935-4858
Entity
Organization

Contact information

Practice address
2706 BURNT VALLEY RD, CHEWELAH, WA 99109-9615
(509) 935-4858
(509) 935-4854
Mailing address
2706 BURNT VALLEY RD, CHEWELAH, WA 99109-9615
(509) 935-4858
(509) 935-4854

Taxonomy

Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
602-900-917
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
602-900-917
UBI NUMBER
WA
Enumeration date
11/09/2011
Last updated
11/09/2011
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