Organization
SUNDOWN M RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LOES SUPD, MBA (DIRECTOR OF OPERATIONS)
(509) 969-0092
Entity
Organization
Contact information
Practice address
2280 STATE ROUTE 821, YAKIMA, WA 98901-8302
(509) 457-0990
Mailing address
PO BOX 217, SELAH, WA 98942-0217
(509) 457-0990
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
RTF-1064
WA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
RTF-1064
WA
324500000X
Substance Abuse Rehabilitation Facility
Primary
RTF-1064
WA
3245S0500X
Children's Substance Abuse Rehabilitation Facility
RTF-1064
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003772
—
WA
Enumeration date
01/20/2007
Last updated
08/23/2022
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