Provider Demographics
NPI:1467933069
Name:WASHINGTON BLOCK, LLC
Entity Type:Organization
Organization Name:WASHINGTON BLOCK, LLC
Other - Org Name:DAX-IT RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:AOD COUNSELOR
Authorized Official - Phone:530-854-4959
Mailing Address - Street 1:PO BOX 6205
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-1205
Mailing Address - Country:US
Mailing Address - Phone:530-854-4959
Mailing Address - Fax:530-854-4902
Practice Address - Street 1:1215 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4810
Practice Address - Country:US
Practice Address - Phone:530-854-4959
Practice Address - Fax:530-854-4902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility