Organization
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA TENGOWSKI (QAIM)
(360) 999-3851
Entity
Organization
Contact information
Practice address
20413 OLD HWY 9 SW, CENTRALIA, WA 98531
(360) 999-7678
Mailing address
PO BOX 45861, OLYMPIA, WA 98504-5861
(360) 999-3851
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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