Provider Demographics
NPI:1205017316
Name:DELOZIER RECOVERY SERVICES LLC
Entity Type:Organization
Organization Name:DELOZIER RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-469-5515
Mailing Address - Street 1:3907 CREEKSIDE LOOP
Mailing Address - Street 2:SUITE 110
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-4879
Mailing Address - Country:US
Mailing Address - Phone:509-469-5515
Mailing Address - Fax:509-469-5517
Practice Address - Street 1:3907 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 110
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4879
Practice Address - Country:US
Practice Address - Phone:509-469-5515
Practice Address - Fax:509-469-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39-1197-00101YA0400X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty