| |
7700 Ne 26th Ave Vancouver WA 98665-0672 | |
(360) 397-8228 | |
(360) 575-1950 |
Full Name | |
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Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
Location | 7700 Ne 26th Ave, Vancouver, Washington |
Authorized Official Name and Position | Shavon Keller (BILLING SUPERVISOR) |
Authorized Official Contact | 3603539431 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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P.o. Box 2429 Longview WA 98632 Ph: (360) 397-8228 | 7700 Ne 26th Ave Vancouver WA 98665-0672 Ph: (360) 397-8228 |
NPI Number | 1164649679 |
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Provider Enumeration Date | 04/19/2007 |
Last Update Date | 07/22/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164649679 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Secondary |
261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
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