Basic Information
| Provider Information | |||||||||
| NPI: | 1891159067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALTY SERVICES III, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 141106 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992141106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092325766 | ||||||||
| FaxNumber: | 5092325770 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 E 5TH ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983623818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604774790 | ||||||||
| FaxNumber: | 3604774802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2016 | ||||||||
| LastUpdateDate: | 04/13/2016 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | ROSEMARIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5092325766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | RTF.FS.60626728 | WA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.