| NPI | 1538412630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVON KELLER Billing Supervisor 360-353-9431 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone |
| Enumeration Date | 2012-10-26 |
| Last Update Date | 2025-09-03 |