1578687240 NPI number — MARY CATHERINES & DAUGHTERS

Table of content: (NPI 1578687240)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578687240 NPI number — MARY CATHERINES & DAUGHTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY CATHERINES & DAUGHTERS
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:
MARY CATHERINE'S
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:
1578687240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10002 AURORA AVE N
Provider Second Line Business Mailing Address:
BLDG. 2, SUITE 12-14
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133-9329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-322-1128
Provider Business Mailing Address Fax Number:
206-322-9239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10002 AURORA AVE N
Provider Second Line Business Practice Location Address:
BLDG. 2, SUITE 12-14
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-9329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-322-1128
Provider Business Practice Location Address Fax Number:
206-322-9239
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RIEDEL
Authorized Official First Name:
MARJORIE
Authorized Official Middle Name:
MARIAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-322-1128

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  151602 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 600309023 , 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: 2035MA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 018994 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1074MA . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9013269 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9558107 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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