Skagit Recovery Center

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

SKAGIT RECOVERY CENTER

Practice address

1905 Continental PL
Mount Vernon, WA 98273-5633

Phone

(360) 428-7835

Fax

(360) 848-9225

NPI assigned

Jan 22, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Alan R Erickson

Title

Executive Director

Phone

(360) 428-7835

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190764800000",
    "number": "1609920123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 CONTINENTAL PL",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735633",
            "fax_number": "360-848-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 CONTINENTAL PL",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735633",
            "telephone_number": "360-428-7835",
            "fax_number": "360-848-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKAGIT RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-09-26",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-428-7835",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1990423",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "06357",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTH PLAN",
            "identifier": "1021475",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skagit Radiology Inc P S
• Skagit Valley Family YMCA
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• Substance Use Disorder Rehabilitation Clinic/Center in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; 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.