NPIMap

Organization Active NPI

Quinault Chemical Depedency

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Taholah, WA
National Provider Identifier
1518180744
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
QUINAULT CHEMICAL DEPEDENCY
Practice address
1505 Kla-Ook-Wa Dr
Taholah, WA 98587-0219
Phone
(360) 276-4405
Fax
(360) 276-9991
NPI assigned
Apr 10, 2007
Last updated
Mar 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

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

Authorized official

Name
David A Hagen, CDPNPI 1760628937
Title
Program Manager
Phone
(360) 276-4405

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

1505 Kla-Ook-Wa Dr
Taholah, WA 98587-0219

Mailing address

PO Box 219
1505 Kla-Ook-Wa Dr
Taholah, WA 98587
Phone (360) 276-4405

Other identifiers 1

IdentifierTypeStateIssuer
1992817MedicaidWA

National Provider Directory

National Provider Directory
Tax ID family
Roger Saux Health Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1330560000000",
    "number": "1518180744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "address_2": "1505 KLA-OOK-WA DR",
            "city": "TAHOLAH",
            "state": "WA",
            "postal_code": "98587",
            "telephone_number": "360-276-4405",
            "fax_number": "360-276-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 KLA-OOK-WA DR",
            "city": "TAHOLAH",
            "state": "WA",
            "postal_code": "985870219",
            "telephone_number": "360-276-4405",
            "fax_number": "360-276-9991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINAULT CHEMICAL DEPEDENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "HAGEN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "360-276-4405",
        "authorized_official_credential": "CDP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992817",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Taholah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.