Healthcare Provider Details

I. General information

NPI: 1013608801
Provider Name (Legal Business Name): 14114 SPOKANE DETOX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14114 E 3RD AVE
SPOKANE VALLEY WA
99216-2102
US

IV. Provider business mailing address

1701 GREEN RD STE C
DEERFIELD BEACH FL
33064-1074
US

V. Phone/Fax

Practice location:
  • Phone: 561-222-1719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA KOROTKEVICH
Title or Position: EXECUTIVE
Credential:
Phone: 561-222-1719