Provider Demographics
NPI:1043281736
Name:LAKE WHATCOM RESIDENTIAL & TREATMENT CENTER
Entity Type:Organization
Organization Name:LAKE WHATCOM RESIDENTIAL & TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE/IT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZAPIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-676-6000
Mailing Address - Street 1:3600 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1756
Mailing Address - Country:US
Mailing Address - Phone:360-676-6000
Mailing Address - Fax:360-676-6006
Practice Address - Street 1:3600 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1756
Practice Address - Country:US
Practice Address - Phone:360-676-6000
Practice Address - Fax:360-676-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 261QR0405X, 324500000X, 363LP2300X
WA028251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7043615Medicaid
A09109Medicare UPIN
WA7043615Medicaid