MEDICARE: TAMARACK 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	323P00000X	Psychiatric Residential Treatment Facility	RTF-1068	WA

General Provider Information

NPI Number	:	1679613905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMARACK CENTER

Provider Business Mailing Address
First Line	:	2901 W FORT GEORGE WRIGHT DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5202
Country	:	US
Telephone Number	:	509-326-8100
Fax Number	:	509-326-9358

Provider Business Practice Location Address
First Line	:	2901 W FORT GEORGE WRIGHT DR
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5202
Country	:	US
Telephone Number	:	509-326-8100
Fax Number	:	509-326-9358

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. TIM DAVIS
Credential	:	M.S.
Telephone Number	:	509-326-8100

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	02/20/2015

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