| NPI | 1265061279 |
|---|---|
| Doing Business As | PROVIDENCE BREAKTHROUGH |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Asst Secretary For Enrollment 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2020-04-02 |