| NPI | 1407143746 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTINE JADE MONTOYA Financial Coordinator 360-679-7676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA 151000298) |
| Additional Taxonomies | 251S00000X (Licence: WA 151000298) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2011-10-13 |