1770614273 NPI number — PUBLIC HOSPITAL DISTRICT NO 1 OF SNOHOMISH COUNTY

Table of content: (NPI 1770614273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770614273 NPI number — PUBLIC HOSPITAL DISTRICT NO 1 OF SNOHOMISH COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUBLIC HOSPITAL DISTRICT NO 1 OF SNOHOMISH COUNTY
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:
EVERGREENHEALTH MONROE RECOVERY CENTER
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:
1770614273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14701 179TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98272-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-794-1447
Provider Business Mailing Address Fax Number:
360-794-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17880 147TH AVENUE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-794-1447
Provider Business Practice Location Address Fax Number:
360-794-1493
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAPLANTE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF QUALITY OFFICER
Authorized Official Telephone Number:
360-794-7497

Provider Taxonomy Codes

  • Taxonomy code: 276400000X , with the licence number:  H104 , 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: 7034564 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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