Organization
PHOENIX RECOVERY SERVICES, LLC
Active
Other names
Phoenix Recovery Services, LLC, Island
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROL RUTH HUNDAHL CDP (OWNER/ADMINISTRATOR)
(360) 848-8437
Entity
Organization
Contact information
Practice address
31640 SR 20 STE 1, OAK HARBOR, WA 98277-3128
(360) 679-7676
(360) 682-5947
Mailing address
1601 E COLLEGE WAY, MOUNT VERNON, WA 98273-5612
(360) 848-8437
(360) 848-5250
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
15145300
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1994649
—
WA
Enumeration date
06/25/2010
Last updated
06/25/2010
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