Healthcare Provider Details

I. General information

NPI: 1720794662
Provider Name (Legal Business Name): RAINIER RECOVERY CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 108TH ST SW
LAKEWOOD WA
98499-3724
US

IV. Provider business mailing address

4909 108TH ST SW
LAKEWOOD WA
98499-3724
US

V. Phone/Fax

Practice location:
  • Phone: 253-544-4772
  • Fax: 253-276-0042
Mailing address:
  • Phone: 253-544-4772
  • Fax: 253-276-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DRAKE ROMEO
Title or Position: CHIEF EXECUTIVE OFFICE
Credential:
Phone: 253-544-4772