Provider Demographics
NPI:1609984681
Name:OLALLA RECOVERY CENTERS
Entity Type:Organization
Organization Name:OLALLA RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSION BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HONSOWETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-857-6101
Mailing Address - Street 1:12851 LALA COVE LN SE
Mailing Address - Street 2:
Mailing Address - City:OLALLA
Mailing Address - State:WA
Mailing Address - Zip Code:98359-9664
Mailing Address - Country:US
Mailing Address - Phone:253-851-6201
Mailing Address - Fax:253-857-3993
Practice Address - Street 1:12851 LALA COVE LN SE
Practice Address - Street 2:
Practice Address - City:OLALLA
Practice Address - State:WA
Practice Address - Zip Code:98359-9664
Practice Address - Country:US
Practice Address - Phone:253-851-6201
Practice Address - Fax:253-857-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA012089324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility