Provider Demographics
NPI:1548627011
Name:WASHINGTON STATE WALLA WALLA VETERANS HOME
Entity type:Organization
Organization Name:WASHINGTON STATE WALLA WALLA VETERANS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-725-2171
Mailing Address - Street 1:92 WAINWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362
Mailing Address - Country:US
Mailing Address - Phone:509-520-9879
Mailing Address - Fax:360-895-4453
Practice Address - Street 1:92 WAINWRIGHT DRIVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:360-895-4710
Practice Address - Fax:360-895-4453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON STATE DEPARTMENT OF VETERANS AFFAIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility