Organization
THE JUANITA CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY R MCCULLOUGH CDP, SAP, NCAC (DIRECTOR)
(425) 328-9528
Entity
Organization
Contact information
Practice address
627 5TH ST, SUITE 100A, MUKILTEO, WA 98275-1580
(425) 328-9528
(425) 786-9276
Mailing address
627 5TH ST, SUITE 100A, MUKILTEO, WA 98275-1580
(425) 328-9528
(425) 786-9276
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
31-1480-00
WA
Other
Enumeration date
08/26/2016
Last updated
08/27/2016
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