Provider Demographics
NPI:1144640772
Name:WALLA WALLA SENIOR CITIZENS CENTER INC
Entity type:Organization
Organization Name:WALLA WALLA SENIOR CITIZENS CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-527-3775
Mailing Address - Street 1:720 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3953
Mailing Address - Country:US
Mailing Address - Phone:509-527-3775
Mailing Address - Fax:509-527-3776
Practice Address - Street 1:720 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3953
Practice Address - Country:US
Practice Address - Phone:509-527-3775
Practice Address - Fax:509-527-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600120674251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable