| NPI | 1013444181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WAYNE LONG Administrator 360-960-8595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA 145800) |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2017-05-18 |