Provider Demographics
NPI:1366907636
Name:BLUE MOUNTAIN INDUSTRIES LLC
Entity type:Organization
Organization Name:BLUE MOUNTAIN INDUSTRIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:DAUDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-525-5433
Mailing Address - Street 1:2616 E ISAACS AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2222
Mailing Address - Country:US
Mailing Address - Phone:509-525-5433
Mailing Address - Fax:509-525-5484
Practice Address - Street 1:2616 E ISAACS AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2222
Practice Address - Country:US
Practice Address - Phone:509-525-5433
Practice Address - Fax:509-525-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management