1194728105 NPI number — NAVOS

Table of content: (NPI 1194728105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194728105 NPI number — NAVOS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NAVOS
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:
HIGHLINE WEST SEATTLE MENTAL HEALTH
Provider Other Organization Name Type Code:
4
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:
1194728105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 46420
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:
98146-0420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-933-7214
Provider Business Mailing Address Fax Number:
206-933-7005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 SW HOLDEN ST
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:
98126-3505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-933-7214
Provider Business Practice Location Address Fax Number:
206-933-7005
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
MARVIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
206-933-7225

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  048 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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