Healthcare Provider Details

I. General information

NPI: 1609984681
Provider Name (Legal Business Name): OLALLA RECOVERY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 LALA COVE LN SE
OLALLA WA
98359-9664
US

IV. Provider business mailing address

12851 LALA COVE LN SE
OLALLA WA
98359-9664
US

V. Phone/Fax

Practice location:
  • Phone: 253-851-6201
  • Fax: 253-857-3993
Mailing address:
  • Phone: 253-851-6201
  • Fax: 253-857-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number012089
License Number StateWA

VIII. Authorized Official

Name: MS. PARIS LYNN HONSOWETZ
Title or Position: ADMISSION BILLING SPECIALIST
Credential:
Phone: 253-857-6101