Provider Demographics
NPI:1003150202
Name:SOUND RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:SOUND RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-533-4220
Mailing Address - Street 1:201 VALLEY AVE NW
Mailing Address - Street 2:A
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-3305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 VALLEY AVE NW
Practice Address - Street 2:A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-3305
Practice Address - Country:US
Practice Address - Phone:253-848-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001624251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health