Provider Demographics
NPI:1609920123
Name:SKAGIT RECOVERY CENTER
Entity Type:Organization
Organization Name:SKAGIT RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-428-7835
Mailing Address - Street 1:1905 CONTINENTAL PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5633
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:360-848-9225
Practice Address - Street 1:1905 CONTINENTAL PL
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5633
Practice Address - Country:US
Practice Address - Phone:360-428-7835
Practice Address - Fax:360-848-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1990423Medicaid
WA06357OtherREGENCE BLUE SHIELD
WA1021475OtherCOMMUNITY HEALTH PLAN