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NPI Code Detail

MEDICARE: SEQUOIA DETOX CENTERS LLC

MEDICARE: SEQUOIA DETOX CENTERS 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
1261QM0850XAdult Mental Health Clinic/Center
2261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
3324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1487289567
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEQUOIA DETOX CENTERS LLC
Provider Business Mailing Address
First Line : 10305 E MONTGOMERY DR
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99206-4220
Country : US
Telephone Number : 509-418-2108
Fax Number : 509-315-9386
Provider Business Practice Location Address
First Line : 10305 E MONTGOMERY DR
Second Line :
City : SPOKANE VALLEY
State : WA
Zip : 99206-4220
Country : US
Telephone Number : 206-605-2209
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MRS. AUDREY GRIMM
Credential : ARNP
Telephone Number : 509-873-4066
Provider Enumeration Date : 03/09/2020
Last Update Date : 10/15/2024

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Directions to “SEQUOIA DETOX CENTERS LLC ” Practice Location

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