Provider Demographics
NPI:1144451048
Name:ASIAN AMERICAN CHEMICAL DEPENDENCY TREATMENT SERVICES
Entity type:Organization
Organization Name:ASIAN AMERICAN CHEMICAL DEPENDENCY TREATMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TAE
Authorized Official - Middle Name:SON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:253-302-3826
Mailing Address - Street 1:9100 BRIDGEPORT WAY SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2427
Mailing Address - Country:US
Mailing Address - Phone:253-302-3826
Mailing Address - Fax:253-267-5212
Practice Address - Street 1:9102 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2418
Practice Address - Country:US
Practice Address - Phone:253-302-3826
Practice Address - Fax:253-267-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QM2800X
WA27145700261QR0405X, 251S00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2001629Medicaid