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NPI Code Detail

MEDICARE: NISQUALLY GENERATIONS HEALING CENTER

MEDICARE: NISQUALLY GENERATIONS HEALING 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
1261QM2800XMethadone Clinic
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1427935832
Entity Type Code : Organization
Provider Name (Legal Business Name) : NISQUALLY GENERATIONS HEALING CENTER
Provider Business Mailing Address
First Line : 3661 PACIFIC AVE SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98501-2122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3661 PACIFIC AVE SE
Second Line :
City : OLYMPIA
State : WA
Zip : 98501-2122
Country : US
Telephone Number : 360-349-3723
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : CHRISTOPHER PETROZZI
Credential :
Telephone Number : 360-218-7970
Provider Enumeration Date : 08/18/2025
Last Update Date : 08/18/2025

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