=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558384990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALLARD RECOVERY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5715 20TH AVE NW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98107-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-784-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 CALIFORNIA AVE SW SUITE D
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98136-1501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-932-9025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. DEANNA MUELLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-784-8600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | OP00001308
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------