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NPI Code Detail

MEDICARE: STEVENS COUNTY

MEDICARE: STEVENS COUNTY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
3251S00000XCommunity/Behavioral Health Agency332001193WA

General Provider Information

NPI Number : 1891792966
Entity Type Code : Organization
Provider Name (Legal Business Name) : STEVENS COUNTY
Provider Business Mailing Address
First Line : 165 E HAWTHORNE AVE
Second Line :
City : COLVILLE
State : WA
Zip : 99114-2629
Country : US
Telephone Number : 509-684-4597
Fax Number : 509-684-5286
Provider Business Practice Location Address
First Line : 165 E HAWTHORNE AVE
Second Line :
City : COLVILLE
State : WA
Zip : 99114-2629
Country : US
Telephone Number : 509-684-4597
Fax Number : 509-684-5286
Authorized Official
Title or Position : HUMAN RESOURCES
Name : ROBERTA BROZIK
Credential :
Telephone Number : 509-685-0629
Provider Enumeration Date : 07/05/2005
Last Update Date : 01/11/2019

Similar Medicare Providers

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165 E HAWTHORNE AVE
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1538238191 — MARY L HAGSTROM CDP
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165 E HAWTHORNE AVE
COLVILLE, WA
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1174692958 — PAULA M CULLER MS, LMHC, DMHP
Practice Location Address:
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COLVILLE, WA
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1578632972 — MELODY A WILSON RC
Practice Location Address:
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Directions to “STEVENS COUNTY ” Practice Location

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