1437362746 NPI number — PUGET SOUND NEIGHBORHOOD HEALTH CENTERS

Table of content: MRS. CHRISTINA MARIE LANDON B.C.B.A (NPI 1144776394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437362746 NPI number — PUGET SOUND NEIGHBORHOOD HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUGET SOUND NEIGHBORHOOD HEALTH CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437362746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
905 SPRUCE ST
Provider Second Line Business Mailing Address:
STE. 300
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98104-2474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-461-6935
Provider Business Mailing Address Fax Number:
206-461-8382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8402 30TH AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98126-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-923-2809
Provider Business Practice Location Address Fax Number:
206-923-2818
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SECORD
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
206-461-6935

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7901275 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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