Provider Demographics
NPI:1487905154
Name:COUNTY OF ADAMS
Entity type:Organization
Organization Name:COUNTY OF ADAMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-488-4074
Mailing Address - Street 1:425 E MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1146
Mailing Address - Country:US
Mailing Address - Phone:509-488-5611
Mailing Address - Fax:509-488-0166
Practice Address - Street 1:425 E MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:OTHELLO
Practice Address - State:WA
Practice Address - Zip Code:99344-1146
Practice Address - Country:US
Practice Address - Phone:509-488-5611
Practice Address - Fax:509-488-0166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF ADAMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-21
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA008251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1981745Medicaid