NPIMap

Organization Active NPI

Shoalwater Bay Wellness Center

Doing business as Shoalwater Bay Clinic

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Tokeland, WA
National Provider Identifier
1649567363
Registry record updated Jul 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
261QR0405X Issued in WA
Legal business name
SHOALWATER BAY WELLNESS CENTER
Doing business as
Shoalwater Bay Clinic
Practice address
2373 Tokeland Road Building. E
Tokeland, WA 98590-0500
Phone
(360) 267-0119
Fax
(360) 267-0417
NPI assigned
Jul 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2011

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

Authorized official

Name
Mr. F Scott Powell, DC.
Title
Health Director
Phone
(360) 267-8130

Specialties & licenses 1

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

Addresses

Primary practice location

2373 Tokeland Road Building. E
Tokeland, WA 98590-0500

Mailing address

PO Box 500
Tokeland, WA 98590-0500
Phone (360) 267-0119

Other identifiers 1

IdentifierTypeStateIssuer
CP00005324OtherWACDP

Other names 1

  • Shoalwater Bay Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shoalwater Bay Tribe7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309478400000",
    "number": "1649567363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "985900500",
            "telephone_number": "360-267-0119",
            "fax_number": "360-267-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2373 TOKELAND ROAD BUILDING. E",
            "city": "TOKELAND",
            "state": "WA",
            "postal_code": "985900500",
            "telephone_number": "360-267-0119",
            "fax_number": "360-267-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOALWATER BAY WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-01",
        "last_updated": "2011-07-01",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "F",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "HEALTH DIRECTOR",
        "authorized_official_telephone_number": "360-267-8130",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC."
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "261QR0405X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDP",
            "identifier": "CP00005324",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shoalwater Bay Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tokeland, WA

Sources for this page

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