Organization
PORT GAMBLE S'KLALLAM TRIBE
Active
Organization
PORT GAMBLE S'KLALLAM TRIBE
Active
Parent organization
PORT GAMBLE S'KLALLAM TRIBE
Other names
Tribal Medicaid FQHC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PORT GAMBLE S'KLALLAM TRIBE
Authorized official
KERSTIN M POWELL (HEALTH SERVICES BUSINESS MANAGER)
(360) 297-9649
Entity
Organization
Contact information
Practice address
32014 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9734
(360) 297-9614
(360) 297-9614
Mailing address
32020 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9734
(360) 297-9614
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/07/2020
Last updated
07/07/2020
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