Provider Demographics
NPI:1598109407
Name:SPOKANE ADDICTION RECOVERY CENTERS
Entity Type:Organization
Organization Name:SPOKANE ADDICTION RECOVERY CENTERS
Other - Org Name:SPARC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWNLOW
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CDP
Authorized Official - Phone:509-624-3251
Mailing Address - Street 1:812 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3326
Mailing Address - Country:US
Mailing Address - Phone:509-624-3251
Mailing Address - Fax:509-624-4505
Practice Address - Street 1:520 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3320
Practice Address - Country:US
Practice Address - Phone:509-624-5228
Practice Address - Fax:509-624-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
WA283261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601 139 572OtherUBI
WA1991165Medicaid