Provider Demographics
NPI:1467857904
Name:OLYMPIC RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:OLYMPIC RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-515-0070
Mailing Address - Street 1:8645 MARTIN WAY E # 100
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5851
Mailing Address - Country:US
Mailing Address - Phone:360-515-0070
Mailing Address - Fax:928-708-9620
Practice Address - Street 1:8645 MARTIN WAY E # 100
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-5851
Practice Address - Country:US
Practice Address - Phone:360-515-0070
Practice Address - Fax:928-708-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34166800261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder