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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
12083P0901XPublic Health & General Preventive Medicine Physician
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1487531661
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 : 360-218-7970
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : CHRISTOPHER PETROZZI
Credential :
Telephone Number : 360-218-7970
Provider Enumeration Date : 08/19/2025
Last Update Date : 08/19/2025

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Directions to “NISQUALLY GENERATIONS HEALING CENTER ” Practice Location

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