Provider Demographics
NPI:1538726252
Name:ALTA VISTA INTEGRATED LIFE SERVICES
Entity type:Organization
Organization Name:ALTA VISTA INTEGRATED LIFE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:360-900-7190
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98322-0010
Mailing Address - Country:US
Mailing Address - Phone:360-900-7190
Mailing Address - Fax:
Practice Address - Street 1:7282 STINSON AVE STE B
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-4930
Practice Address - Country:US
Practice Address - Phone:855-201-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2142431Medicaid