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General NPI Number Information
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NPI Number | 1578375879
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Entity Type | Organization
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Legal Business Name | RAPHAEL RECOVERY AND SUPPORT LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 2024 CATON WAY SW
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City | OLYMPIA
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State | WA
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Zip | 98502-8201
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Country | US
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Telephone | 657-767-4837
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Fax | 800-507-2906
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Provider Business Mailing Address
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Address Line | 7848 23RD LN SE
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City | LACEY
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State | WA
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Zip | 98503-3300
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Country | US
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Telephone | 406-461-0960
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIA VALDENEGRO
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Credential |
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Telephone | 406-461-0960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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