Provider Demographics
NPI:1225300213
Name:FREE BY THE SEA AT SUNSET VIEW FREEDOM CENTER
Entity Type:Organization
Organization Name:FREE BY THE SEA AT SUNSET VIEW FREEDOM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICKEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-665-4494
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:25517 PARK AVENUE
Mailing Address - City:OCEAN PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98640-0399
Mailing Address - Country:US
Mailing Address - Phone:360-665-4494
Mailing Address - Fax:360-665-6528
Practice Address - Street 1:25517 PARK AVE.
Practice Address - Street 2:
Practice Address - City:OCEAN PARK
Practice Address - State:WA
Practice Address - Zip Code:98640-0399
Practice Address - Country:US
Practice Address - Phone:360-665-4494
Practice Address - Fax:360-665-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF.FS.60221179324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility