Organization
RESURGENCE NORTHWEST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN RICHARD BERGERON SUDPT, AAC, CPC (OWNER, CEO)
(360) 888-7087
Entity
Organization
Contact information
Practice address
1703 DOUGLAS CT, MILTON, WA 98354-9727
(360) 888-7087
Mailing address
1703 DOUGLAS CT, MILTON, WA 98354-9727
(360) 888-7087
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/13/2024
Last updated
08/13/2024
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