NPIMap

Organization Active NPI

Tacoma Detoxification Center

  • Substance Abuse Rehabilitation Facility
  • Tacoma, WA
National Provider Identifier
1285757450
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
RTF1067 Issued in WA
Legal business name
TACOMA DETOXIFICATION CENTER
Practice address
721 Fawcett Ave
Suite 100
Tacoma, WA 98402-5502
Phone
(253) 593-2413
Fax
(253) 627-4817
NPI assigned
Apr 10, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Mary Elizabeth Degruy
Title
Program Director
Phone
(253) 284-7821

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X RTF1067 WA Primary

Addresses

Primary practice location

721 Fawcett Ave
Suite 100
Tacoma, WA 98402-5502

Mailing address

721S Fawcett
Ste 100
Tacoma, WA 98402-5502
Phone (253) 593-2413

Other identifiers 1

IdentifierTypeStateIssuer
1994219MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Metropolitan Development Council4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285757450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721S FAWCETT",
            "address_2": "STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025502",
            "telephone_number": "253-593-2413",
            "fax_number": "253-627-4817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 FAWCETT AVE",
            "address_2": "SUITE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025502",
            "telephone_number": "253-593-2413",
            "fax_number": "253-627-4817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TACOMA DETOXIFICATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEGRUY",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "253-284-7821",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "WA",
            "license": "RTF1067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1994219",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.