Provider Demographics
NPI:1154970010
Name:AXIUM RECOVERY SERVICES
Entity type:Organization
Organization Name:AXIUM RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR /OWENER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:SUDP
Authorized Official - Phone:509-474-1148
Mailing Address - Street 1:222 W MISSION AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2347
Mailing Address - Country:US
Mailing Address - Phone:509-474-1148
Mailing Address - Fax:509-413-1625
Practice Address - Street 1:222 W MISSION AVE STE 106
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2347
Practice Address - Country:US
Practice Address - Phone:509-474-1148
Practice Address - Fax:509-413-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1194008649Medicaid