MEDICARE: WHEELER SERVICES, INC. DBA: RIVERCREST TREATMENT CENTER

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
1	251S00000X	Community/Behavioral Health Agency	06035300	WA

General Provider Information

NPI Number	:	1952536427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHEELER SERVICES, INC. DBA: RIVERCREST TREATMENT CENTER

Provider Business Mailing Address
First Line	:	PO BOX 576
Second Line	:
City	:	BRUSH PRAIRIE
State	:	WA
Zip	:	98606-0576
Country	:	US
Telephone Number	:	360-696-3307
Fax Number	:	360-695-1892

Provider Business Practice Location Address
First Line	:	1801 D ST STE 5
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98663-3376
Country	:	US
Telephone Number	:	360-696-3307
Fax Number	:	360-695-1892

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT VERN WHEELER
Credential	:	CDP, NCACII, SAP
Telephone Number	:	360-696-3307

Provider Enumeration Date	:	05/27/2009
Last Update Date	:	05/27/2009

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