| NPI | 1679970925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN A RUSSO Part Owner 206-658-3920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA LH60320548) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: WA LH60500437) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2014-12-02 |