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General NPI Number Information
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NPI Number | 1629362108
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Entity Type | Organization
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Legal Business Name | PIERCE COUNTY ALLIANCE
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 2000 LAKERIDGE DR. SW BLDG. 2 THURSTON COUNTY DRUG COURT
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City | OLYMPIA
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State | WA
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Zip | 98502
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Country | US
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Telephone | 360-357-2482
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Fax |
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Provider Business Mailing Address
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Address Line | 510 TACOMA AVE S
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City | TACOMA
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State | WA
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Zip | 98402-5416
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Country | US
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Telephone | 253-502-5403
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Fax | 253-272-6788
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Authorized Official
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Title or Position | CFO
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Name | MR. JOHN S NEISWENDER
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Credential |
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Telephone | 253-502-5403
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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 | 34140400
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License Number State | WA
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