=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144295080
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEPARTMENT OF SOCIAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 10/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9601 STEILACOOM BLVD SW
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98498-7213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-582-8900
-----------------------------------------------------
Fax | 253-756-2963
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9601 STEILACOOM BLVD SW
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98498-7212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-582-8900
-----------------------------------------------------
Fax | 253-756-2963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM MEDICAL DIRECTOR
-----------------------------------------------------
Name | MR. DONALD BRENT LITEANU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 253-756-2599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------