Provider Demographics
NPI:1336990423
Name:RESOURCES UNITED SUPPORTIVE SERVICE
Entity type:Organization
Organization Name:RESOURCES UNITED SUPPORTIVE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-260-4584
Mailing Address - Street 1:1548 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3293
Mailing Address - Country:US
Mailing Address - Phone:520-260-4584
Mailing Address - Fax:
Practice Address - Street 1:1801 1ST AVE STE 4A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3271
Practice Address - Country:US
Practice Address - Phone:520-260-4584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESOURCES UNITED SUPPORTIVE SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)