Provider Demographics
NPI:1609156298
Name:KASSUHN INC
Entity type:Organization
Organization Name:KASSUHN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KASSUHN
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:253-538-2323
Mailing Address - Street 1:17002 PACIFIC AVE S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8253
Mailing Address - Country:US
Mailing Address - Phone:253-538-2323
Mailing Address - Fax:253-538-2988
Practice Address - Street 1:17002 PACIFIC AVE S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8253
Practice Address - Country:US
Practice Address - Phone:253-538-2323
Practice Address - Fax:253-538-2988
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KASSUHN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-26
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004989324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility