Provider Demographics
NPI:1669787883
Name:ANAMASTE MASSAGE
Entity type:Organization
Organization Name:ANAMASTE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE PRACTITIONER
Authorized Official - Phone:509-216-4340
Mailing Address - Street 1:14415 W CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:CHENEY
Mailing Address - State:WA
Mailing Address - Zip Code:99004-9763
Mailing Address - Country:US
Mailing Address - Phone:509-216-4340
Mailing Address - Fax:
Practice Address - Street 1:14415 W CAMERON RD
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-9763
Practice Address - Country:US
Practice Address - Phone:509-216-4340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60141870314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility