| NPI | 1952792921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEODORE R MAUSSHARDT Owner 425-736-6075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA FC00000188) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |