Basic Information
| Provider Information | |||||||||
| NPI: | 1326123670 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIVE PROJECT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 W MAXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093255502 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1803 W MAXWELL AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5093255502 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | LODGE | ||||||||
| AuthorizedOfficialFirstName: | TONI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5093255502 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 133V00000X | WA | N | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | 163W00000X | WA | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 163WD0400X | RN00122081 | WA | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Diabetes Educator | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 291U00000X | 50D0968048 | WA | N | Laboratories | Clinical Medical Laboratory | 363LF0000X | WA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 261QF0400X | 601182805 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 7591100 | 05 | WA | MEDICAID | 7098320 | 05 | WA | MEDICAID | 1003480 | 05 | WA | MEDICAID | 1007817 | 05 | WA | MEDICAID |