1548565393 NPI number — MULTICARE HEALTH SYSTEMS

Table of content: (NPI 1548565393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548565393 NPI number — MULTICARE HEALTH SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULTICARE HEALTH SYSTEMS
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:
GOOD SAMARITAN BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1548565393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
325 E PIONEER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-3265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-697-8333
Provider Business Mailing Address Fax Number:
253-770-7018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 E PIONEER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98372-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-697-8333
Provider Business Practice Location Address Fax Number:
253-770-7018
Provider Enumeration Date:
01/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
TRAN
Authorized Official First Name:
HIEN
Authorized Official Middle Name:
Authorized Official Title or Position:
AMBULATORY PHARMACY MANAGER
Authorized Official Telephone Number:
253-403-3687

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 60199585 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2127663 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1548565393 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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