Provider Demographics
NPI:1407143746
Name:ISLAND COUNTY RECOVERY SERVICES
Entity Type:Organization
Organization Name:ISLAND COUNTY RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:JADE
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-679-7676
Mailing Address - Street 1:31640 SR 20
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3128
Mailing Address - Country:US
Mailing Address - Phone:360-679-7676
Mailing Address - Fax:360-682-5947
Practice Address - Street 1:31640 SR 20
Practice Address - Street 2:SUITE 1
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3128
Practice Address - Country:US
Practice Address - Phone:360-679-7676
Practice Address - Fax:360-682-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA151000298251S00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health