| NPI | 1407492085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL WOODLAND Credentialing Specialist 253-681-6601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2019-11-19 |
| Last Update Date | 2019-11-19 |