Healthcare Provider Details

I. General information

NPI: 1225186448
Provider Name (Legal Business Name): SOCIAL TREATMENT OPPORTUNITY PROGRAMS II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST SUITE 112
TACOMA WA
98409-7264
US

IV. Provider business mailing address

PO BOX 111297
TACOMA WA
98411-1297
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-0890
  • Fax: 253-471-0891
Mailing address:
  • Phone: 253-471-0890
  • Fax: 253-284-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number188/27012702
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number188/27012702
License Number StateWA

VIII. Authorized Official

Name: MR. ANDREW LEE TATUM
Title or Position: COO/CFO
Credential: MBA
Phone: 253-471-0890