| NPI | 1366050833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE EDWARD BEANBLOSSOM Executive Director 360-714-9355 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |