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General NPI Number Information
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NPI Number | 1134373574
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Entity Type | Organization
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Legal Business Name | C & R EXECUTIVES, LLC
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 309 OAK ST
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City | KELSO
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State | WA
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Zip | 98626-2340
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Country | US
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Telephone | 360-577-7442
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Fax | 360-577-7904
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Provider Business Mailing Address
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Address Line | PO BOX 1077
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City | KELSO
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State | WA
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Zip | 98626-0111
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Country | US
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Telephone | 360-577-7442
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. CATHY KAY LUDAHL
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Credential | C.D.P.
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Telephone | 360-577-7442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 325/08 0535 00
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 325/08 0535 00
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 08 053500
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License Number State | WA
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