Healthcare Provider Details

I. General information

NPI: 1831003987
Provider Name (Legal Business Name): PACIFIC RIDGE INTENSIVE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 PACIFIC AVE
TACOMA WA
98418-7838
US

IV. Provider business mailing address

3701 PACIFIC AVE
TACOMA WA
98418-7838
US

V. Phone/Fax

Practice location:
  • Phone: 253-921-0364
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BORAY THACH
Title or Position: MEDICAL DIRECTOR
Credential: DNP, PMHNP-BC
Phone: 253-921-0364