Provider Demographics
NPI:1063834539
Name:CHILD ENRICHMENT CENTER LLC
Entity Type:Organization
Organization Name:CHILD ENRICHMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:HAWS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, BCBA
Authorized Official - Phone:808-284-7225
Mailing Address - Street 1:1430 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7615
Mailing Address - Country:US
Mailing Address - Phone:808-284-7225
Mailing Address - Fax:
Practice Address - Street 1:1950 KEENE RD BLDG L
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7752
Practice Address - Country:US
Practice Address - Phone:858-521-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA031251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA031OtherWASHINGTON STATE DEPT OF SOCIAL & HEALTH SERVICES COMMUNITY MENTAL HEALTH SERVIC