Provider Demographics
NPI:1497080931
Name:SOCIAL TREATMENT OPPORTUNITY PROGRAMS II, INC
Entity Type:Organization
Organization Name:SOCIAL TREATMENT OPPORTUNITY PROGRAMS II, INC
Other - Org Name:STOP SHELTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:253-471-0890
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-0126
Mailing Address - Country:US
Mailing Address - Phone:360-426-5654
Mailing Address - Fax:360-426-5641
Practice Address - Street 1:611 W COTA ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2241
Practice Address - Country:US
Practice Address - Phone:360-426-5654
Practice Address - Fax:360-426-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management