Provider Demographics
NPI:1467612424
Name:GUARDIAN RECOVERY PROGRAM LLC
Entity Type:Organization
Organization Name:GUARDIAN RECOVERY PROGRAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:206-545-0597
Mailing Address - Street 1:4812 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6518
Mailing Address - Country:US
Mailing Address - Phone:206-545-0597
Mailing Address - Fax:
Practice Address - Street 1:4812 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6518
Practice Address - Country:US
Practice Address - Phone:206-545-0597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17046100261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA602518096OtherUBI