Resurgence Northwest LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

RESURGENCE NORTHWEST LLC

Practice address

1703 Douglas CT
Milton, WA 98354-9727

Phone

(360) 888-7087

NPI assigned

Aug 13, 2024

Last updated

Aug 13, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Richard Bergeron, SUDPT, AAC, CPCNPI 1700527280

Title

Owner, Ceo

Phone

(360) 888-7087

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevin R Bergeron, SUDPT

  • Addiction (Substance Use Disorder) Counselor
  • Milton, WA
  • NPI 1700527280
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1225869969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 DOUGLAS CT",
            "city": "MILTON",
            "state": "WA",
            "postal_code": "983549727",
            "telephone_number": "360-888-7087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 DOUGLAS CT",
            "city": "MILTON",
            "state": "WA",
            "postal_code": "983549727",
            "telephone_number": "360-888-7087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESURGENCE NORTHWEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER, CEO",
        "authorized_official_telephone_number": "360-888-7087",
        "authorized_official_credential": "SUDPT, AAC, CPC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ismaelita Proctor
• Logan Wayne Ramsey, LMP
• Ashley Remington
• Remnant Army Northwest
• Remnant Cleaning LLC
• Albina V Reznichenko
• Bria Denise Rice
• James Andrew Rife, ND MED
• Janine Annette Rodriguez Colletta
• Ida M Rogers, D.C.

• Community/Behavioral Health Agency in Milton, WA
• Providers in Milton, WA by specialty
• Community/Behavioral Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.