Organization
A CHANGE INTO RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVE HARRIS CDP, NCAC (ADMINISTRATOR)
(253) 841-8165
Entity
Organization
Contact information
Practice address
719 E MAIN, SUITE C, PUYALLUP, WA 98372-3306
(253) 841-8165
(253) 841-8168
Mailing address
719 E MAIN, SUITE C, PUYALLUP, WA 98372-3306
(253) 841-8165
(253) 841-8168
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CP00002706
WA
Other
Enumeration date
12/10/2015
Last updated
12/10/2015
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