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General NPI Number Information
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NPI Number | 1760979298
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Entity Type | Organization
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Legal Business Name | CASCADE EVALUATION AND TREATMENT CENTER
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 3510 STEELHAMMER DR
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City | CENTRALIA
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State | WA
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Zip | 98531-4551
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Country | US
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Telephone | 360-623-8020
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Fax | 360-623-7070
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Provider Business Mailing Address
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Address Line | 3510 STEELHAMMER DR
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City | CENTRALIA
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State | WA
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Zip | 98531-4551
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Country | US
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Telephone | 360-623-8020
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Fax | 360-623-7070
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RICHARD STRIDE
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Credential | LMHC, PSYD
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Telephone | 360-330-9044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 60811831
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License Number State | WA
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