Provider Demographics
NPI:1366050833
Name:CASCADE CONNECTIONS
Entity type:Organization
Organization Name:CASCADE CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BEANBLOSSOM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:360-714-9355
Mailing Address - Street 1:P.O. BOX 3174
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-3174
Mailing Address - Country:US
Mailing Address - Phone:360-714-9355
Mailing Address - Fax:360-312-0332
Practice Address - Street 1:1354 PACIFIC PLACE
Practice Address - Street 2:SUITE 101
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248
Practice Address - Country:US
Practice Address - Phone:360-714-9355
Practice Address - Fax:360-312-0332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASCADE CONNECTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1117241OtherPROVIDERONE ID