Organization
TACOMA DETOXIFICATION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ELIZABETH DEGRUY (PROGRAM DIRECTOR)
(253) 284-7821
Entity
Organization
Contact information
Practice address
721 FAWCETT AVE, SUITE 100, TACOMA, WA 98402-5502
(253) 593-2413
(253) 627-4817
Mailing address
721S FAWCETT, STE 100, TACOMA, WA 98402-5502
(253) 593-2413
(253) 627-4817
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
RTF1067
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1994219
—
WA
Enumeration date
04/10/2007
Last updated
08/22/2020
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