| NPI | 1053995340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHALINI CHATAN Credentialing Specialist 360-475-6718 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2021-05-12 |