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General NPI Number Information
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NPI Number | 1497809958
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Entity Type | Organization
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Legal Business Name | A NEW SPIRIT RECOVERY PROGRAM INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22617 76TH AVE W SUITE 101
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City | EDMONDS
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State | WA
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Zip | 98026
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Country | US
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Telephone | 425-771-1194
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Fax | 425-771-4544
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Provider Business Mailing Address
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Address Line | 22617 76TH AVE W SUITE 101
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City | EDMONDS
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State | WA
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Zip | 98026
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Country | US
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Telephone | 425-771-1194
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Fax | 425-771-4544
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Authorized Official
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Title or Position | PRESIDENT CLINICAL DIRECTOR
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Name | MR. DONALD D COX
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Credential | NCACII CCDCII CDD
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Telephone | 425-771-1194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 31011000
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License Number State | WA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 477000
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | PREMERA BLUE CROSS
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Identifier #2
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Identifier Code | 321001
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | VALUEOPTIONS
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Identifier #3
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Identifier Code | NO-0620
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | REGENCE BLUE SHIELD
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 321001
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Identifier Type | OTHER
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Identifier State |
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Identifier Issuer | VALUEOPTIONS
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Identifier #2
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Identifier Code | 477000
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | PREMERA BLUE CROSS
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Identifier #3
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Identifier Code | NO-0620
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Identifier Type | OTHER
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Identifier State | WA
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Identifier Issuer | REGENCE BLUE SHIELD
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