A Change Into Recovery, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

CP00002706 Issued in WA

Legal business name

A CHANGE INTO RECOVERY, LLC

Practice address

719 E Main
Suite C
Puyallup, WA 98372-3306

Phone

(253) 841-8165

Fax

(253) 841-8168

NPI assigned

Dec 10, 2015

Organization subpart

No

Name

Mr. Dave Harris, CDP, NCAC

Title

Administrator

Phone

(253) 841-8165

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 10, 2015.

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1386019727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 E MAIN",
            "address_2": "SUITE C",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723306",
            "telephone_number": "253-841-8165",
            "fax_number": "253-841-8168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 E MAIN",
            "address_2": "SUITE C",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723306",
            "telephone_number": "253-841-8165",
            "fax_number": "253-841-8168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A CHANGE INTO RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "253-841-8165",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CDP, NCAC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "CP00002706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.