Organization Name: | INTEGRITY SUPPORT SERVICES, LLC |
NPI Number: | 1174812168 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GERARDO CASTILLEJA (ADMINISTRATOR) |
Mailing Address: | 303 Division St Grandview |
State: | WA US |
Postal Code: | 989301358 |
Phone Number: | 5098828012 |
Fax Number: | 5098828802 |
NPI Enumeration Date: | 03/30/2011 |
NPI Last Update Date: | 03/30/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0405X |
License Number: | 39 1532 00 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
Taxonomy Definition: |