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General NPI Number Information
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NPI Number | 1649668666
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Entity Type | Organization
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Legal Business Name | SPECIALTY SERVICES 2 LLC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 825 E 5TH ST
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City | PORT ANGELES
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State | WA
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Zip | 98362-3818
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Country | US
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Telephone | 360-477-4790
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 141106
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City | SPOKANE VALLEY
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State | WA
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Zip | 99214-1106
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Country | US
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Telephone | 509-232-5766
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Fax | 509-242-1867
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Authorized Official
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Title or Position | CONTROLLER
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Name | DANA MUNDY
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Credential |
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Telephone | 509-209-8822
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 603230607
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License Number State | WA
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