Provider Demographics
NPI:1679613905
Name:TAMARACK CENTER
Entity Type:Organization
Organization Name:TAMARACK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:509-326-8100
Mailing Address - Street 1:2901 W FORT GEORGE WRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-5202
Mailing Address - Country:US
Mailing Address - Phone:509-326-8100
Mailing Address - Fax:509-326-9358
Practice Address - Street 1:2901 W FORT GEORGE WRIGHT DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5202
Practice Address - Country:US
Practice Address - Phone:509-326-8100
Practice Address - Fax:509-326-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF-1068323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility