Provider Demographics
NPI:1215286851
Name:ABHS SPECIALITY SERVICES 1 LLC
Entity type:Organization
Organization Name:ABHS SPECIALITY SERVICES 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-232-5766
Mailing Address - Street 1:PO BOX 9977
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99209-0977
Mailing Address - Country:US
Mailing Address - Phone:509-232-5766
Mailing Address - Fax:509-232-5770
Practice Address - Street 1:44 E COZZA DR
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6514
Practice Address - Country:US
Practice Address - Phone:509-232-5766
Practice Address - Fax:509-232-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603230354324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility