Provider Demographics
NPI:1396817375
Name:CATHOLIC COMMUNITY SERVICES WESTERN WASHINGTON
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES WESTERN WASHINGTON
Other - Org Name:CCS RECOVERY CENTER- BELLINGHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CDP
Authorized Official - Phone:360-676-2187
Mailing Address - Street 1:515 LAKEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5233
Mailing Address - Country:US
Mailing Address - Phone:360-676-2187
Mailing Address - Fax:360-676-2162
Practice Address - Street 1:515 LAKEWAY DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5233
Practice Address - Country:US
Practice Address - Phone:360-676-2187
Practice Address - Fax:360-676-2162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37078600261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1994672Medicaid