1770642696 NPI number — NEIGHBORCARE HEALTH

Table of content: (NPI 1770642696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770642696 NPI number — NEIGHBORCARE HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORCARE HEALTH
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:
NEIGHBORCARE HEALTH AT WEST SEATTLE HIGH SCHOOL
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:
1770642696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 12TH AVE S STE 901
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98144-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-548-3114
Provider Business Mailing Address Fax Number:
206-762-6355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 CALIFORNIA 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:
98116-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-658-8048
Provider Business Practice Location Address Fax Number:
206-658-8063
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ERIKSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
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: 7123474 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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