Organization
ABSTEMIOUS OUTPATIENT CLINIC, INC
Active
Parent organization
ABSTEMIOUS OUTPATIENT CLINIC, INC
Other names
Ronald J. Phelps, B.A., CDP
Organization subpart
Yes
Provider details
NPI number
Legal business name
ABSTEMIOUS OUTPATIENT CLINIC, INC
Authorized official
RONALD J PHELPS B.A., C.D.P. (EXECUTIVE DIRECTOR ABSTEMIOUS OUTPA)
(509) 927-7814
Entity
Organization
Contact information
Practice address
10525 E MAIN AVE, SPOKANE VALLEY, WA 99206-3728
(509) 927-7814
(509) 927-4669
Mailing address
10525 E. MAIN AVE, SPOKANE VALLEY, WA 99206-3728
(509) 927-7814
(509) 927-4669
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
32051201
WA
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
CP0001358
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32051200
DSHS
WA
01
—
32051200/32051201
DSHS/DBHR
WA
01
—
32051201
DASA
WA
Enumeration date
02/01/2007
Last updated
10/23/2012
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