Healthcare Provider Details

I. General information

NPI: 1336303387
Provider Name (Legal Business Name): UNITED NORTHWEST RECOVERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 06/07/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S. 3RD STREET
MT. VERNON WA
98273
US

IV. Provider business mailing address

904 S. 3RD STREET
MT. VERNON WA
98273
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-6300
  • Fax: 564-209-7048
Mailing address:
  • Phone: 360-856-6300
  • Fax: 564-209-7048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateWA

VIII. Authorized Official

Name: MS. JACKIE ELAINE WASHBISH
Title or Position: DIRECTOR
Credential: SUDP
Phone: 360-856-6300