1184185514 NPI number — UNITY CARE NORTHWEST

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 1184185514 NPI number — UNITY CARE NORTHWEST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITY CARE NORTHWEST
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:
1184185514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1616 CORNWALL AVE STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-4642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-676-6177
Provider Business Mailing Address Fax Number:
360-671-3574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARL COZIER ELEMENTARY SCHOOL BH SERVICES
Provider Second Line Business Practice Location Address:
1330 LINCOLN ST
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-676-6177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2019

Additional Information

Authorized Official

Authorized Official Last Name:
JOYCE
Authorized Official First Name:
JODI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
360-676-6177

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2127210 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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