NPIMap

Organization Active NPI

Phoenix Recovery Services, LLC

Doing business as Phoenix Recovery Services, LLC, Island

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Oak Harbor, WA
National Provider Identifier
1467763276
Registry record updated Jun 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
15145300 Issued in WA
Legal business name
PHOENIX RECOVERY SERVICES, LLC
Doing business as
Phoenix Recovery Services, LLC, Island
Practice address
31640 Sr 20 Ste 1
Oak Harbor, WA 98277-3128
Phone
(360) 679-7676
Fax
(360) 682-5947
NPI assigned
Jun 25, 2010
Last updated
Jun 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2010

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

Authorized official

Name
Mrs. Carol Ruth Hundahl, CDP
Title
Owner/Administrator
Phone
(360) 848-8437

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 15145300 WA Primary

Addresses

Primary practice location

31640 Sr 20 Ste 1
Oak Harbor, WA 98277-3128

Mailing address

1601 E College Way
Mount Vernon, WA 98273-5612
Phone (360) 848-8437

Other identifiers 1

IdentifierTypeStateIssuer
1994649MedicaidWA

Other names 1

  • Phoenix Recovery Services, LLC, Island Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Phoenix Recovery Services LLC2 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

1601 E College Way
Mount Vernon, WA 98273
Phone (360) 763-5595

NPI Registry JSON

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1467763276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 E COLLEGE WAY",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735612",
            "telephone_number": "360-848-8437",
            "fax_number": "360-848-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31640 SR 20 STE 1",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982773128",
            "telephone_number": "360-679-7676",
            "fax_number": "360-682-5947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RECOVERY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-25",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "HUNDAHL",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "360-848-8437",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CDP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "15145300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1994649",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Recovery Services, LLC, Island",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oak Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; 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.