Provider Demographics
NPI:1720470057
Name:METROPOLITAN DEVELOPMENT COUNCIL
Entity Type:Organization
Organization Name:METROPOLITAN DEVELOPMENT COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREBOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-591-0113
Mailing Address - Street 1:945 FAWCETT AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5612
Mailing Address - Country:US
Mailing Address - Phone:253-284-9049
Mailing Address - Fax:
Practice Address - Street 1:721 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5502
Practice Address - Country:US
Practice Address - Phone:253-207-4302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARTF.FS.60503763320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness