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EXHIBIT A -7 <br />FACILITY LOCATIONS AND PROVIDER ROSTERS <br />GROUP CONTRACT INFORMATION <br />Group Legal Name <br />Kittitas County Sheriff's Office <br />Group DBA Name <br />Kittitas County Sheriffs Office <br />Group TIN/(EIN) <br />91-6001349 <br />Group NPI <br />1063226272 <br />1. Please complete the following Location Roster for all locations to be covered under this Agreement: <br />LOCATION to be LINKED to CONTRACT <br />Location Name <br />Kittitas County Jail <br />Street Address 1 <br />205 W 5t4 Ave. Ste 1 <br />a <br />Street Address 2 <br />0 <br />City <br />Ellensburg <br />State <br />WA <br />Zip <br />98926 <br />u <br />Office Phone <br />509-962-7527 <br />Office Fax <br />TIN: Same as above? <br />Yes N <br />No O <br />NPI: Same as above? <br />Yes N <br />No O <br />LOCATION to be LINKED to CONTRACT <br />Location Name <br />Kittitas County Sheriffs Office <br />Street Address 1 <br />307 W Umptanum Road <br />bStreet <br />Address 2 <br />0 <br />City <br />Ellensburg <br />State <br />WA <br />Zip <br />98926 <br />u <br />o <br />a <br />Office Phone <br />509-962-7525 <br />Office Fax <br />TIN: Same as above? <br />Yes N <br />No O <br />NPI: Same as above? <br />Yes N <br />No O <br />LOCATION to be LINKED to CONTRACT <br />Location Name <br />Street Address 1 <br />U <br />a <br />Street Address 2 <br />0 <br />City <br />State <br />Zip <br />u <br />j <br />Office Phone <br />Office Fax <br />TIN: Same as above? <br />Yes O <br />No O <br />NPI: Same as above? <br />Yes O <br />No O <br />2020 Facility Agrat — Template Page 25 of 51 Contract #{Contract #1-{PRC Agreement 1D) <br />