NPIMap

Organization Active NPI

Educational Service District 113

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Raymond, WA
National Provider Identifier
1285886655
Registry record updated Sep 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
25143100 Issued in WA
Legal business name
EDUCATIONAL SERVICE DISTRICT 113
Practice address
22 Viking Way
Raymond, WA 98577-9308
Phone
(360) 942-2006
NPI assigned
Oct 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2009

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

Authorized official

Name
Mr. Robert M Vincent, MA, CDP
Title
Administrator
Phone
(360) 790-2207

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 25143100 WA Primary

Addresses

Primary practice location

22 Viking Way
Raymond, WA 98577-9308

Mailing address

601 McPhee Rd SW
Olympia, WA 98502-5080
Phone (360) 464-6874

Other identifiers 1

IdentifierTypeStateIssuer
1995885MedicaidWA

Other names 1

  • True North Treatment Other name

National Provider Directory

National Provider Directory
Tax ID family
Educational Service District 1138 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

151 NE Hampe Way
Ste C2-1
Chehalis, WA 98532
Phone (360) 748-2274

22 Viking Way
Raymond, WA 98577
Phone (360) 942-2006

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253750400000",
    "number": "1285886655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MCPHEE RD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025080",
            "telephone_number": "360-464-6874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 VIKING WAY",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985779308",
            "telephone_number": "360-942-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDUCATIONAL SERVICE DISTRICT 113",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2009-09-24",
        "status": "A",
        "authorized_official_last_name": "VINCENT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-790-2207",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, CDP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "25143100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1995885",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "True North Treatment",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Raymond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2009; 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.