NPIMap

Organization Active NPI

Educational Service District 113

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Shelton, WA
National Provider Identifier
1952437824
Registry record updated Mar 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
23105800 Issued in WA
Legal business name
EDUCATIONAL SERVICE DISTRICT 113
Practice address
807 W Pine St
Shelton, WA 98584-2562
Phone
(360) 427-2050
NPI assigned
Feb 26, 2007
Last updated
Mar 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2008

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

Authorized official

Name
Mr. Robert M Vincent, MA, CDP
Title
Administrator
Phone
(360) 790-2207

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 23105800 WA Primary

Addresses

Primary practice location

807 W Pine St
Shelton, WA 98584-2562

Mailing address

601 McPhee Rd SW
Olympia, WA 98502-5080
Phone (360) 464-6874

Other identifiers 1

IdentifierTypeStateIssuer
1994060MedicaidWA

Other names 1

  • True North Treatment Other name

National Provider Directory

National Provider Directory
Tax ID family
Educational Service District 1138 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

601 McPhee Rd SW
Olympia, WA 98502
Phone (360) 706-6280

807 W Pine St
Shelton, WA 98584
Phone (360) 427-2050

1315 Yelm Ave W
Yelm, WA 98597
Phone (360) 458-6124

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1952437824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MCPHEE RD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025080",
            "telephone_number": "360-464-6874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 W PINE ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842562",
            "telephone_number": "360-427-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDUCATIONAL SERVICE DISTRICT 113",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "VINCENT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-790-2207",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA, CDP"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "23105800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1994060",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "True North Treatment",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shelton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 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.