| NPI | 1336438407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM KENT LOVELESS Administrator 360-516-6592 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA CP00004660) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2014-07-29 |