Provider Demographics
NPI:1366837650
Name:WEST SOUND TREATMENT CENTER (POULSBO)
Entity type:Organization
Organization Name:WEST SOUND TREATMENT CENTER (POULSBO)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:O'GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-876-9430
Mailing Address - Street 1:19351 8TH AVE NE
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8710
Mailing Address - Country:US
Mailing Address - Phone:360-876-9430
Mailing Address - Fax:360-876-0713
Practice Address - Street 1:19351 8TH AVE NE
Practice Address - Street 2:SUITE # 204
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8710
Practice Address - Country:US
Practice Address - Phone:360-876-9430
Practice Address - Fax:360-876-0713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST SOUND TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600554448261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA18169700Medicaid