| NPI | 1801018528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELODY KAY LORENZO Administrator 360-423-2806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA 251S00000X) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-22 |