1164845178 NPI number — THE SHAMROCK GROUP, INC.

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 1164845178 NPI number — THE SHAMROCK GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SHAMROCK GROUP, INC.
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:
1164845178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10564 5TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98125-7200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-789-4784
Provider Business Mailing Address Fax Number:
206-789-4786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10564 5TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-789-4784
Provider Business Practice Location Address Fax Number:
206-789-4786
Provider Enumeration Date:
01/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUMANN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
EINAR
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
206-789-4784

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  17 0097 00 , 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: 17 0097 00 . This is a "DSHS, DIVISION OF BEHAVIORAL HEALTH AND RECOVERY (DBHR)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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