Basic Information
| Provider Information | |||||||||
| NPI: | 1780991844 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAKE WHATCOM RESIDENTIAL & TREATMENT CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LAKE WHATCOM CETNER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 609 NORTHSHORE DR | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982264414 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 609 NORTHSHORE DR | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982264414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606766000 | ||||||||
| FaxNumber: | 3606766006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 09/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | OTA | ||||||||
| AuthorizedOfficialFirstName: | NAOMI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMISSION/COMMUNITY CASE MANGER | ||||||||
| AuthorizedOfficialTelephone: | 3609277065 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.