Organization
LONG TERM CARE DIVISION OF OCPHD 4
Active
Other names
North Valley Extended Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALAN ULRICH (CFO)
(509) 486-3113
Entity
Organization
Contact information
Practice address
22 W 1ST ST, TONASKET, WA 98855-8846
(509) 486-3152
(509) 486-3116
Mailing address
22 W 1ST ST, TONASKET, WA 98855-8846
(509) 486-3152
(509) 486-3116
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
H-107
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4210704
—
WA
Enumeration date
12/05/2006
Last updated
11/05/2020
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