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General NPI Number Information
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NPI Number | 1467612424
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Entity Type | Organization
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Legal Business Name | GUARDIAN RECOVERY PROGRAM LLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 4812 AURORA AVE N
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City | SEATTLE
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State | WA
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Zip | 98103-6518
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Country | US
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Telephone | 206-545-0597
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Fax |
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Provider Business Mailing Address
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Address Line | 4812 AURORA AVE N
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City | SEATTLE
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State | WA
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Zip | 98103-6518
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Country | US
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Telephone | 206-545-0597
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LYNDA J. WHITCOMB
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Credential | CDP
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Telephone | 206-545-0597
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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 | 17046100
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License Number State | WA
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