Provider Demographics
NPI:1588737506
Name:OLALLA RECOVERY CENTES
Entity type:Organization
Organization Name:OLALLA RECOVERY CENTES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PARIS
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HONSOWETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-851-2552
Mailing Address - Street 1:5122 OLYMPIC DR NW STE A105
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1768
Mailing Address - Country:US
Mailing Address - Phone:253-851-2552
Mailing Address - Fax:253-858-8506
Practice Address - Street 1:5122 OLYMPIC DR NW STE A105
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1768
Practice Address - Country:US
Practice Address - Phone:253-851-2552
Practice Address - Fax:253-858-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health