Provider Demographics
NPI:1053800417
Name:KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON
Entity type:Organization
Organization Name:KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-445-1147
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:USK
Mailing Address - State:WA
Mailing Address - Zip Code:99180-0039
Mailing Address - Country:US
Mailing Address - Phone:509-447-7299
Mailing Address - Fax:
Practice Address - Street 1:1981 N LECLERC
Practice Address - Street 2:
Practice Address - City:USK
Practice Address - State:WA
Practice Address - Zip Code:99180
Practice Address - Country:US
Practice Address - Phone:509-447-7299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA26X043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA26X04OtherWA DEPT OF HEALTH