| NPI | 1104090372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DYLAN ALAN BRASHEAR Administrator 360-714-8180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA 602791805) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-07-23 |