Provider Demographics
NPI:1174812168
Name:INTEGRITY SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:INTEGRITY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLEJA
Authorized Official - Suffix:
Authorized Official - Credentials:CDPT
Authorized Official - Phone:509-882-8012
Mailing Address - Street 1:303 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1358
Mailing Address - Country:US
Mailing Address - Phone:509-882-8012
Mailing Address - Fax:509-882-8802
Practice Address - Street 1:303 DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1358
Practice Address - Country:US
Practice Address - Phone:509-882-8012
Practice Address - Fax:509-882-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39 1532 00261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder