MEDICARE: ABHS PORT ANGELES OUTPATIENT PROGRAM

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1477419869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABHS PORT ANGELES OUTPATIENT PROGRAM

Provider Business Mailing Address
First Line	:	15404 E SPRINGFIELD AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99037-8569
Country	:	US
Telephone Number	:	253-227-3802
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 E 1ST ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4317
Country	:	US
Telephone Number	:	509-232-5766
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANTHONY ARTHURE PRENTICE
Credential	:
Telephone Number	:	360-507-8028

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	01/08/2026

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