Provider Demographics
NPI:1407928013
Name:PALOUSE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:PALOUSE RECOVERY CENTER LLC
Other - Org Name:PRC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER OF LLC
Authorized Official - Prefix:MS
Authorized Official - First Name:DARCELL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:CHEMICAL DEPENDENCY
Authorized Official - Phone:509-334-0718
Mailing Address - Street 1:SE 1240 BISHOP BLVD
Mailing Address - Street 2:SUITE P
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163
Mailing Address - Country:US
Mailing Address - Phone:509-334-0718
Mailing Address - Fax:509-334-0361
Practice Address - Street 1:SE 1240 BISHOP BOULEVARD
Practice Address - Street 2:SUITE P
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163
Practice Address - Country:US
Practice Address - Phone:509-334-0718
Practice Address - Fax:509-334-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38075500324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility