MEDICARE: SOUND RECOVERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	NT00001624	WA

General Provider Information

NPI Number	:	1003150202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUND RECOVERY CENTER, LLC

Provider Business Mailing Address
First Line	:	201 VALLEY AVE NW
Second Line	:	A
City	:	PUYALLUP
State	:	WA
Zip	:	98371-3305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 VALLEY AVE NW
Second Line	:	A
City	:	PUYALLUP
State	:	WA
Zip	:	98371-3305
Country	:	US
Telephone Number	:	253-848-3363
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	MR. MATTHEW LUCHINI
Credential	:
Telephone Number	:	928-533-4220

Provider Enumeration Date	:	11/12/2012
Last Update Date	:	11/12/2012

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