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PROVIDER AND LOCATION DETAIL

The following information is provided to inform the setup process – whether the user is entering information into the data fields him or herself or verifying the information entered by DSHS, it is important to understand exactly what information is needed for each data field.

The Provider Detail and Location Detail page #ORG010 consists of five (5) tabs.

CLICK ON the tab names below for additional Help information and instructions on completing the data fields.

1. PROVIDER INFORMATION TAB
   • This tab includes information about your provider organization’s Business Type, Provider Type, Business Phone Number, etc.
2. ADDRESSES TAB
   • Address Type and Address details are documented under this tab.
3. IDENTIFIERS TAB
   • Identifier Type and Identifier Text, along with Begin date and End date are stored under this tab.
4. CONTACTS TAB
   • Detailed information about Contact Type and Contacts is stored here.
5. LOCATIONS TAB
   • This tab displays the locations set by the user for the provider.