1316459845 NPI number — NORTHBOUND TREATMENT SERVICES OF WASHINGTON, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316459845 NPI number — NORTHBOUND TREATMENT SERVICES OF WASHINGTON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHBOUND TREATMENT SERVICES OF WASHINGTON, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316459845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3822 CAMPUS DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-2636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-650-4334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 2ND AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98119-3928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-629-8947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/FOUNDER
Authorized Official Telephone Number:
949-269-9201

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  200495 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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