Provider Demographics
NPI:1316118177
Name:UNITED NW RECOVERY CENTER INC.
Entity type:Organization
Organization Name:UNITED NW RECOVERY CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-856-6300
Mailing Address - Street 1:605 SUNSET PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-1589
Mailing Address - Country:US
Mailing Address - Phone:360-856-6300
Mailing Address - Fax:
Practice Address - Street 1:605 SUNSET PARK DR STE B
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1589
Practice Address - Country:US
Practice Address - Phone:360-856-6300
Practice Address - Fax:360-854-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1234OtherDASA