Provider Demographics
NPI:1831597319
Name:SPOKANE DETOX CENTER LLC
Entity type:Organization
Organization Name:SPOKANE DETOX CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:STURM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-442-6666
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-1269
Mailing Address - Country:US
Mailing Address - Phone:928-442-6666
Mailing Address - Fax:
Practice Address - Street 1:524 E FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1038
Practice Address - Country:US
Practice Address - Phone:928-442-6666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility