Provider Demographics
NPI:1336303387
Name:UNITED NORTHWEST RECOVERY CENTER INC.
Entity Type:Organization
Organization Name:UNITED NORTHWEST RECOVERY CENTER INC.
Other - Org Name:UNITED NW RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/SUDP
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WASHBISH
Authorized Official - Suffix:
Authorized Official - Credentials:SUDP
Authorized Official - Phone:360-856-6300
Mailing Address - Street 1:904 S. 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:MT. VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273
Mailing Address - Country:US
Mailing Address - Phone:360-856-6300
Mailing Address - Fax:564-209-7048
Practice Address - Street 1:904 S. 3RD STREET
Practice Address - Street 2:
Practice Address - City:MT. VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273
Practice Address - Country:US
Practice Address - Phone:360-856-6300
Practice Address - Fax:564-209-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA25Other25