RESIDENCE XII (NPI# 1942220868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942220868 |
| Entity Type | Organization |
| Organization Name | RESIDENCE XII |
| Practice Address |
12029 113th Ave Ne Kirkland WA 98034-6901 |
| Practice Telephone | 4258238844 |
| Practice Fax Number | 4258202371 |
| Mailing Telephone | 4258238844 |
| Mailing Fax Number | 4258202371 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2008-07-28 |
| Authorized Official Name | AMBER KILWINE (EXECUTIVE ASSISTANT) |
| Authorized Official Telephone | 4258238844 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 17005200 | WA | Residential Treatment Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | RESIDENCE XII FOUNDATION | 14950 Ne 147th Pl, Woodinville, WA 98072-9009 |
| Street Address |
12029 113TH AVE NE |
| City | KIRKLAND |
| State | WA |
| Zip Code | 98034-6901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235758665 | Tbh Psychiatry of California PC | Psychiatry & Neurology | 12029 113th Ave Ne, Kirkland, WA 98034-6901 | 2020-04-15 |
| 1790329258 | Washington Health Operations LLC | Clinic/Center | 12029 113th Ave Ne, Kirkland, WA 98034-6901 | 2019-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578116596 | Rachel Bowers | Behavior Technician | 1335 Northeast 122nd Way, Suite 105, Kirkland, WA 98034 | 2019-07-18 |
| 1740841048 | Kristina Louise Inghram | Behavior Technician | 11415 Ne 128th St., Suite 40, Kirkland, WA 98034 | 2019-06-26 |
| 1053978064 | Matthew A. Bagnulo, Dds, Ps | Dentist | 11830 Ne 128th St., #202, Kirkland, WA 98034 | 2019-05-24 |
| 1629568928 | Stephanie Michalko | Optometrist | 11800 Ne 128th St Ste 110, Kirkland, WA 98034 | 2018-05-14 |
| 1952800013 | Heath Family Counseling LLC | Marriage & Family Therapist | 12025 115th Ave. Ne, Building D, Ste 200, Kirkland, WA 98034 | 2018-02-05 |
| 1891202834 | Barbara Josephine Gorham | Counselor | 2025 115th Ave Ne, Bldg D, #200, Kirkland, WA 98034 | 2017-12-29 |
| 1548782915 | Eleanor Hollis Wall | Counselor | 14340 102nd Ave Ne, Kirkland, WA 98034 | 2017-07-07 |
| 1457885212 | Peter Schoonmaker | Hospitalist | 12040 Ne 128th Street, Ms105, Kirkland, WA 98034 | 2017-04-18 |
| 1780124370 | Rebecca Managan | Advanced Practice Midwife | 12303 Ne 130th Ln Ste Coral225, Kirkland, WA 98034 | 2017-03-01 |
| 1669821104 | Winter Gonzalez | Counselor | 11720 97th Ln Ne Apt A411, Kirkland, WA 98034 | 2016-06-06 |
| Find all providers in zip 98034 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760090518 | Hotel California By The Sea Bellevue, LLC. | Substance Abuse Rehabilitation Facility | 7810 130th Ave Ne, Kirkland, WA 98033-8251 | 2020-07-17 |
| 1417020355 | Lakeside Recovery Centers Inc | Substance Abuse Rehabilitation Facility | 10322 Ne 132nd St, Kirkland, WA 98034 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730787763 | For The Culture Counseling Services | Substance Abuse Rehabilitation Facility | 4301 S Pine St Ste 92, Tacoma, WA 98409-7259 | 2020-10-12 |
| 1629532569 | Sandra Ann Moore | Substance Abuse Rehabilitation Facility | 2632 E 17th St, Bremerton, WA 98310-5058 | 2019-01-24 |
| 1972085835 | Peninsula Counseling, LLC | Substance Abuse Rehabilitation Facility | 3214 50th Street Ct Nw Ste D-305, Gig Harbor, WA 98335-8589 | 2018-09-06 |
| 1356831911 | American Behavioral Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 44 E Cozza Dr Ste B, Spokane, WA 99208-6514 | 2018-05-18 |
| 1609365238 | American Behavioral Health Systems, Inc. | Substance Abuse Rehabilitation Facility | 500 Se Adams Ave, Chehalis, WA 98532 | 2018-05-09 |
| 1023515400 | Evergreen Recovery Centers | Substance Abuse Rehabilitation Facility | 1905 Continental Place, Mount Vernon, WA 98273 | 2018-04-11 |
| 1588184980 | Evergreen Recovery Centers-lynnwood Detox | Substance Abuse Rehabilitation Facility | 20508 56th Ave W, Lynnwood, WA 98036 | 2017-06-27 |
| 1346785524 | Big Change Medical | Substance Abuse Rehabilitation Facility | 26857 16th Ave S, Des Moines, WA 98198-9327 | 2016-12-27 |
| 1881062362 | Sea-mar Community Health Center | Substance Abuse Rehabilitation Facility | 113 23rd Ave S, Seattle, WA 98144-2309 | 2015-09-14 |
| 1073995080 | The Haven Detox Center LLC | Substance Abuse Rehabilitation Facility | 8649 Martin Way E, Lacey, WA 98516-5812 | 2015-06-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.