1114058195 NPI number — COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114058195 NPI number — COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
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:
6
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:
1114058195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13060
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:
98206-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-789-3700
Provider Business Mailing Address Fax Number:
425-789-3750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4111 194TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-835-5204
Provider Business Practice Location Address Fax Number:
425-835-5205
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PT ACCOUNT MANAGER
Authorized Official Telephone Number:
425-789-3700

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7034036 , 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: 8934243 . This is a "CRIME VICTIMS COMPENSATIO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 32770 . This is a "WORKMEN COMPENSATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5010921 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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