Provider Demographics
NPI:1730962689
Name:REMNANT ARMY NORTHWEST
Entity type:Organization
Organization Name:REMNANT ARMY NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:SUDPT, AAC
Authorized Official - Phone:360-888-7087
Mailing Address - Street 1:2825 MILTON WAY UNIT 1032
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9494
Mailing Address - Country:US
Mailing Address - Phone:360-888-7087
Mailing Address - Fax:
Practice Address - Street 1:1703 DOUGLAS CT
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9727
Practice Address - Country:US
Practice Address - Phone:360-888-7087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder