Provider Demographics
NPI:1205074440
Name:WOMEN'S RECOVERY CENTER
Entity type:Organization
Organization Name:WOMEN'S RECOVERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-547-2996
Mailing Address - Street 1:4649 SUNNYSIDE AVE N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-6900
Mailing Address - Country:US
Mailing Address - Phone:206-547-2996
Mailing Address - Fax:206-547-5187
Practice Address - Street 1:4649 SUNNYSIDE AVE N
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6900
Practice Address - Country:US
Practice Address - Phone:206-547-2996
Practice Address - Fax:206-547-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17044000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA17 0440 00OtherDASA (DEPARTMENT OF ALCOHOL AND SUBSTANCE ABUSE)