NPIMap

Organization Active NPI

Port Gardner Bay Recovery

  • Community/Behavioral Health Agency
  • Everett, WA
National Provider Identifier
1447555644
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
31114400 Issued in WA
Legal business name
PORT GARDNER BAY RECOVERY
Practice address
2722 Colby Ave
Suite 424
Everett, WA 98201-3557
Phone
(425) 252-4656
Fax
(425) 252-4308
NPI assigned
Jan 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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

Authorized official

Name
Ms. Kimberli J McCabe, CDP
Title
Owner
Phone
(425) 252-4656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 31114400 WA Primary

Addresses

Primary practice location

2722 Colby Ave
Suite 424
Everett, WA 98201-3557

Mailing address

2722 Colby Ave
Suite 424
Everett, WA 98201-3557
Phone (425) 252-4656

National Provider Directory

National Provider Directory
Tax ID family
Insights2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2722 Colby Ave
Ste 424
Everett, WA 98201
Phone (425) 252-4656

NPI Registry JSON

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295395200000",
    "number": "1447555644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2722 COLBY AVE",
            "address_2": "SUITE 424",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013557",
            "telephone_number": "425-252-4656",
            "fax_number": "425-252-4308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2722 COLBY AVE",
            "address_2": "SUITE 424",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982013557",
            "telephone_number": "425-252-4656",
            "fax_number": "425-252-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT GARDNER BAY RECOVERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-19",
        "last_updated": "2011-01-19",
        "status": "A",
        "authorized_official_last_name": "MCCABE",
        "authorized_official_first_name": "KIMBERLI",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-252-4656",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CDP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "31114400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; 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.