Provider Demographics
NPI:1497809958
Name:A NEW SPIRIT RECOVERY PROGRAM INC
Entity type:Organization
Organization Name:A NEW SPIRIT RECOVERY PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:NCACII CCDCII CDD
Authorized Official - Phone:425-771-1194
Mailing Address - Street 1:22617 76TH AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-771-1194
Mailing Address - Fax:425-771-4544
Practice Address - Street 1:22617 76TH AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-771-1194
Practice Address - Fax:425-771-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA31011000324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA477000OtherPREMERA BLUE CROSS
321001OtherVALUEOPTIONS
WANO-0620OtherREGENCE BLUE SHIELD