Provider Demographics
NPI:1871146506
Name:TACOMA RECOVERY CAFE
Entity type:Organization
Organization Name:TACOMA RECOVERY CAFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-533-9361
Mailing Address - Street 1:813 MLK JR. WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4147
Mailing Address - Country:US
Mailing Address - Phone:253-533-9361
Mailing Address - Fax:253-597-4177
Practice Address - Street 1:813 MLK JR. WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4147
Practice Address - Country:US
Practice Address - Phone:253-533-9361
Practice Address - Fax:253-597-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management