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General NPI Number Information
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NPI Number | 1487029708
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Entity Type | Organization
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Legal Business Name | BHARDRA RECOVERY
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 18500 156TH AVE NE #300
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City | WOODINVILLE
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State | WA
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Zip | 98072
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Country | US
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Telephone | 206-957-0721
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Fax | 206-957-0723
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Provider Business Mailing Address
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Address Line | 18500 156TH AVE NE #300
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City | WOODINVILLE
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State | WA
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Zip | 98072
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Country | US
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Telephone | 206-957-0721
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Fax | 206-957-0723
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Authorized Official
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Title or Position | DIRECTOR, OWNER
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Name | JESSICA CAROL DARK
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Credential | SUDD
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Telephone | 206-957-0721
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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 | 17 113800
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License Number State | WA
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Taxonomy #2
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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 |
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License Number State |
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