Residence XII

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

17005200 Issued in WA

Legal business name

RESIDENCE XII

Practice address

12029 113TH Ave NE
Kirkland, WA 98034-6901

Phone

(425) 823-8844

Fax

(425) 820-2371

NPI assigned

Jul 21, 2006

Organization subpart

No

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

Authorized official

Name

Amber Kilwine

Title

Executive Assistant

Phone

(425) 823-8844

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217203200000",
    "number": "1942220868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12029 113TH AVE NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346901",
            "telephone_number": "425-823-8844",
            "fax_number": "425-820-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12029 113TH AVE NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980346901",
            "telephone_number": "425-823-8844",
            "fax_number": "425-820-2371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESIDENCE XII",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2008-07-28",
        "status": "A",
        "authorized_official_last_name": "KILWINE",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "425-823-8844"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "WA",
            "license": "17005200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Substance Abuse Rehabilitation Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; 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.