| NPI | 1083701015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA M FERGUSON Director Of Operations And Complian 360-385-0321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-02-07 |