1265554463 NPI number — PIONEER HUMAN SERVICES

Table of content: (NPI 1265554463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265554463 NPI number — PIONEER HUMAN SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIONEER HUMAN SERVICES
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:
PIONEER COUNSELING SERVICES SEATTLE - RAINIER CLINIC
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:
1265554463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7440 W. MARGINAL WAY S.
Provider Second Line Business Mailing Address:
PIONEER HUMAN SERVICES - CONTRACTS
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98108-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-768-1990
Provider Business Mailing Address Fax Number:
206-768-8910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 RAINIER AVENUE S.
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:
98144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-470-3856
Provider Business Practice Location Address Fax Number:
206-470-3857
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOOLWORTH
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, TREATMENT & REENTRY
Authorized Official Telephone Number:
206-766-7018

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  160 , 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: 1995083 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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