Provider Demographics
NPI:1518017136
Name:COUNTY OF PIERCE
Entity Type:Organization
Organization Name:COUNTY OF PIERCE
Other - Org Name:PIERCE COUNTY RESIDENTIAL TREATMENT FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-798-6100
Mailing Address - Street 1:3580 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7915
Mailing Address - Country:US
Mailing Address - Phone:253-798-4500
Mailing Address - Fax:253-798-4255
Practice Address - Street 1:3580 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7915
Practice Address - Country:US
Practice Address - Phone:253-798-4500
Practice Address - Fax:253-798-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF1077251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA146315OtherL&I
WA146315OtherL&I