1770737934 NPI number — CASCADE PSYCHIATRIC SERVICES, PSC

Table of content: (NPI 1770737934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770737934 NPI number — CASCADE PSYCHIATRIC SERVICES, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE PSYCHIATRIC SERVICES, PSC
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:
1770737934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3802 BROADWAY STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-5032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-259-6665
Provider Business Mailing Address Fax Number:
425-259-6014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3802 BROADWAY STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-5032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-259-6665
Provider Business Practice Location Address Fax Number:
425-259-6014
Provider Enumeration Date:
11/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KLAMP
Authorized Official First Name:
WOLFGANG
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
425-259-6665

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  AP30007181 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: MD00023385 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: MD00045550 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: MD00009424 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: AP30007788 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: MD00035512 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: MD00042238 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: MD00037882 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA10003235 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP30007333 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1073575601 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1134178882 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1144276759 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417920810 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1972632560 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1013009273 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1114077138 . This is a "CMS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1902097355 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1275724627 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1477713113 . This is a "CMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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