NPIMap

Organization Active NPI

Conquer Addiction PLLC

  • Adult Mental Health Clinic/Center
  • Monroe, WA
National Provider Identifier
1689494262
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
CONQUER ADDICTION PLLC
Practice address
809 W Main St Ste C
Monroe, WA 98272-2172
Phone
(206) 552-0882
Fax
(844) 440-2147
NPI assigned
Oct 16, 2024
Organization subpart
Yes
Parent organization
CONQUER ADDICTION PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Jacob Adam Grillo, PA-CNPI 1043612575
Title
Owner
Phone
(206) 552-0882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Clinic/Center 261Q00000X
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

809 W Main St Ste C
Monroe, WA 98272-2172

Mailing address

809 W Main St Ste C
Monroe, WA 98272-2172
Phone (206) 552-0882

Other names 2

  • CONQUER Doing business as
  • Conquer Clinics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Conquer Addiction PLLC2 organizations share this tax ID, including this one
Part of
Conquer Addiction PLLC

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1729036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1689494262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 W MAIN ST STE C",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722172",
            "telephone_number": "206-552-0882",
            "fax_number": "844-440-2147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 W MAIN ST STE C",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722172",
            "telephone_number": "206-552-0882",
            "fax_number": "844-440-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONQUER ADDICTION PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONQUER ADDICTION PLLC",
        "enumeration_date": "2024-10-16",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "GRILLO",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-552-0882",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CONQUER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Conquer Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.