Organization
GRAY WOLF RANCH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WOODY BERNAS (PROGRAM DIRECTOR)
(360) 385-5505
Entity
Organization
Contact information
Practice address
3804 HASTINGS AVE W, PORT TOWNSEND, WA 98368-9642
(360) 385-5505
(360) 385-3605
Mailing address
PO BOX 102, PORT TOWNSEND, WA 98368-0102
(360) 571-5505
(360) 385-3605
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
RTF.FS.00001020
WA
Other
Enumeration date
03/22/2012
Last updated
03/22/2012
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