MEDICARE: WOMEN'S RECOVERY CENTER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	17044000	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17 0440 00	OTHER	WA	DASA (DEPARTMENT OF ALCOHOL AND SUBSTANCE ABUSE)

General Provider Information

NPI Number	:	1205074440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S RECOVERY CENTER

Provider Business Mailing Address
First Line	:	4649 SUNNYSIDE AVE N
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98103-6900
Country	:	US
Telephone Number	:	206-547-2996
Fax Number	:	206-547-5187

Provider Business Practice Location Address
First Line	:	4649 SUNNYSIDE AVE N
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98103-6900
Country	:	US
Telephone Number	:	206-547-2996
Fax Number	:	206-547-5187

Authorized Official
Title or Position	:	ADMINISTRATION DIRECTOR
Name	:	MR. JAMES D BUCHANAN
Credential	:
Telephone Number	:	206-547-2996

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	10/21/2011

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