Provider Demographics
NPI:1306111562
Name:ENCOPRESIS TREATMENT CENTER
Entity type:Organization
Organization Name:ENCOPRESIS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATERBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-629-4699
Mailing Address - Street 1:1824 N. 203RD STREET
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133
Mailing Address - Country:US
Mailing Address - Phone:206-629-4699
Mailing Address - Fax:888-972-9414
Practice Address - Street 1:611 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3096
Practice Address - Country:US
Practice Address - Phone:425-640-3227
Practice Address - Fax:425-640-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602025306261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service