Provider Demographics
NPI:1902323819
Name:MUCKLESHOOT INDIAN TRIBE
Entity Type:Organization
Organization Name:MUCKLESHOOT INDIAN TRIBE
Other - Org Name:MUCKLESHOOT IN HOME SUPPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARMONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-876-3050
Mailing Address - Street 1:17500 SE 392ND ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-9705
Mailing Address - Country:US
Mailing Address - Phone:253-876-3050
Mailing Address - Fax:253-876-2974
Practice Address - Street 1:17500 SE 392ND ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-9705
Practice Address - Country:US
Practice Address - Phone:253-876-3050
Practice Address - Fax:253-876-2974
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUCKLESHOOT INDIAN TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health