Organization
NOOKSACK CENTRAL MANAGEMENT SYSTEM
Active
Other names
The Nooksack Hope Chemical Dependency Program
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC R. DAVENPORT (GOVERNMENTAL SERVICE EXEC.)
(360) 592-5176
Entity
Organization
Contact information
Practice address
6750 MISSION RD, EVERSON, WA 98247-9749
(360) 966-7704
(360) 966-4225
Mailing address
PO BOX 157, DEMING, WA 98244-0157
(360) 966-7704
(360) 966-4225
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1993013
—
WA
05
—
1993666
—
WA
Enumeration date
05/09/2007
Last updated
09/09/2011
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