| NPI | 1104243534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES J COFFEE CEO 360-636-3892 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2022-05-31 |