Provider Demographics
NPI:1487289567
Name:SEQUOIA DETOX CENTERS LLC
Entity type:Organization
Organization Name:SEQUOIA DETOX CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-873-4066
Mailing Address - Street 1:10305 E MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4220
Mailing Address - Country:US
Mailing Address - Phone:509-418-2108
Mailing Address - Fax:509-315-9386
Practice Address - Street 1:10305 E MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4220
Practice Address - Country:US
Practice Address - Phone:206-605-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities