| NPI | 1023183597 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC JENSEN Controller 360-236-7170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA 600255953) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2019-12-27 |