Organization
SOUTH CORRECTIONAL ENTITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVON SCHRUM (EXECUTIVE DIRECTOR)
(206) 257-6262
Entity
Organization
Contact information
Practice address
20817 17TH AVE S, DES MOINES, WA 98198-7665
(206) 257-6200
Mailing address
20817 17TH AVE S, DES MOINES, WA 98198-7665
(206) 257-6200
Taxonomy
Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/25/2025
Last updated
02/25/2025
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