STAFFORD CREEK CORRECTION CENTER (NPI# 1952506420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952506420 |
| Entity Type | Organization |
| Organization Name | STAFFORD CREEK CORRECTION CENTER |
| Practice Address |
191 Constantine Way Aberdeen WA 98520-9504 |
| Practice Telephone | 3605372167 |
| Practice Fax Number | 3605372075 |
| Mailing Telephone | 3605372167 |
| Mailing Fax Number | 3605372075 |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. MARC F. STERN (DIRECTOR, HEALTH SERVICES DOC) |
| Authorized Official Telephone | 3607258700 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 251K00000X | Public Health or Welfare | Agencies | ||
| X | 311Z00000X | Custodial Care Facility | Nursing & Custodial Care Facilities | ||
| X | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| X | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
191 CONSTANTINE WAY |
| City | ABERDEEN |
| State | WA |
| Zip Code | 98520-9504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467068452 | Teresa Torres | Psychologist | 191 Constantine Way, Aberdeen, WA 98520-9504 | 2020-09-16 |
| 1730430380 | Erin M Lystad | Physician Assistant | 191 Constantine Way, Aberdeen, WA 98520-9504 | 2012-09-23 |
| 1427349802 | Stafford Creek Corrections Center | Clinic/Center | 191 Constantine Way, Aberdeen, WA 98520-9504 | 2011-04-20 |
| 1215240049 | Luciano Luis Figueroa | Physician Assistant | 191 Constantine Way, Aberdeen, WA 98520-9504 | 2010-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740755354 | Wchs, Inc. | Clinic/Center | 516 East 1st Street, Aberdeen, WA 98520 | 2018-10-10 |
| 1518454180 | Katie Cutshaw | Counselor | 1700 Cherry Street, Suite C, Aberdeen, WA 98520 | 2018-04-18 |
| 1629587738 | Robert Williams | Counselor | Catholic Community Services, 403 West State Street, Suite 206, Aberdeen, WA 98520 | 2017-09-21 |
| 1174032296 | Amy D Tyler | Peer Specialist | 403 W State Street, Ste 206, Aberdeen, WA 98520 | 2017-09-20 |
| 1073032819 | Amanda Leona Franklin | Counselor | 2700 Simpson Ave, Suite 101, Aberdeen, WA 98520 | 2017-09-13 |
| 1184141152 | Chrystal Lynn Beckley | Counselor | 2700 Simpson Avenue Suite 101, Aberdeen, WA 98520 | 2017-08-29 |
| 1285158923 | Josh Butler | Technician/Technologist | 1718 Sumner Ave, Aberdeen, WA 98520 | 2017-08-02 |
| 1386165553 | Melvin Taylor | Counselor | 311 South I Street, Aberdeen, WA 98520 | 2017-06-28 |
| 1164870267 | Kelly Knittle | Counselor | 4820 She-nah-num Dr. Se, Olympia, WA 98520 | 2016-05-31 |
| 1437570249 | Aberdeen Therapy Works | Occupational Therapist | 100 S. I Street, Suite 205, Aberdeen, WA 98520 | 2013-12-20 |
| Find all providers in zip 98520 | ||||
| Taxonomy Code | 251K00000X |
| Grouping | Agencies |
| Classification | Public Health or Welfare |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437473337 | Harford County Health Department | Public Health or Welfare | 253 Paradise Rd, Hchd Teen Diversion, Aberdeen, MD 21001-2324 | 2010-03-22 |
| 1992239172 | Power County Hospital District | Public Health or Welfare | 50 South Main St, Aberdeen, ID 83210 | 2017-04-14 |
| 1053721589 | Mississippi State Department of Health | Public Health or Welfare | 302 S Chestnut St, Aberdeen, MS 39730-3220 | 2014-05-06 |
| 1871725994 | Grays Harbor County Treasurer | Public Health or Welfare | 2109 Sumner Ave, Aberdeen, WA 98520-3600 | 2009-08-24 |
| 1346473477 | Grays Harbor County Treasurer | Public Health or Welfare | 2109 Sumner Ave, Aberdeen, WA 98520-3600 | 2009-08-24 |
| 1164655296 | Grays Harbor County Treasurer | Public Health or Welfare | 2109 Sumner Ave, Aberdeen, WA 98520-3600 | 2009-08-24 |
| 1447442694 | Grays Harbor County Treasurer | Public Health or Welfare | 2109 Sumner Ave, Aberdeen, WA 98520-3600 | 2007-08-13 |
| 1184774796 | Grays Harbor County Treasurer | Public Health or Welfare | 2109 Sumner Ave, Aberdeen, WA 98520-3600 | 2007-01-12 |
| 1992855506 | Grays Harbor County Treasurer | Public Health or Welfare | 2109 Sumner Ave, Aberdeen, WA 98520-3600 | 2007-01-12 |
| 1821002676 | Keypoint Health | Public Health or Welfare | 135 N Parke St, Aberdeen, MD 21001-2428 | 2006-07-28 |
| Find all providers in ABERDEEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.