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EDUCATIONAL SERVICE DISTRICT 113

Ambulatory Health Care Facilities Clinic/Center Rehabilitation, Substance Use Disorder

Provider NPI: 1609902485

Organization Information:
Organization Name:  EDUCATIONAL SERVICE DISTRICT 113
Organization is not Subpart
Authorized Official:  ROBERT M VINCENT  ADMINISTRATOR  360-790-2207

Practice Location:
104 S K ST  ABERDEEN, WA 98520-6200 US
Tel: 360-533-9749  Fax: --

Business Mailing Address:
601 MCPHEE RD SW  OLYMPIA, WA 98502-5080 US
Tel: 360-464-6874  Fax: --

NPI Information:
NPI: 1609902485
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y261QR0405XAmbulatory Health Care Facilities
Clinic/Center
Rehabilitation, Substance Use Disorder
WA14096600

Other Provider Identifiers:

IssuerNumberStateType
1993591WA05



American Medical Association 2012 taxonomy code information

Code: 261QR0405X

Type:

Classification:



Definition:



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