Provider Demographics
NPI:1659122844
Name:REBUILT TREATMENT AND RECOVERY LLC
Entity Type:Organization
Organization Name:REBUILT TREATMENT AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROCQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-505-4438
Mailing Address - Street 1:1220 N HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2410
Mailing Address - Country:US
Mailing Address - Phone:509-505-4415
Mailing Address - Fax:509-621-2011
Practice Address - Street 1:1220 N HOWARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2410
Practice Address - Country:US
Practice Address - Phone:509-505-4415
Practice Address - Fax:509-621-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility