Provider Demographics
NPI:1720127095
Name:CASCADE RECOVERY RESOURCE CENTER, LLC
Entity type:Organization
Organization Name:CASCADE RECOVERY RESOURCE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STONEBURG
Authorized Official - Suffix:
Authorized Official - Credentials:CDP, NCACI
Authorized Official - Phone:509-933-3838
Mailing Address - Street 1:707 N PEARL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-2938
Mailing Address - Country:US
Mailing Address - Phone:509-933-3838
Mailing Address - Fax:509-933-4044
Practice Address - Street 1:707 N PEARL ST
Practice Address - Street 2:SUITE D
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-2938
Practice Address - Country:US
Practice Address - Phone:509-933-3838
Practice Address - Fax:509-933-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602292101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1995299Medicaid