1689754756 NPI number — SILVERDALE PSYCHIATRIC SERVICES, LLC

Table of content: (NPI 1689754756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689754756 NPI number — SILVERDALE PSYCHIATRIC SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVERDALE PSYCHIATRIC SERVICES, LLC
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:
1689754756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9395 LINDER WAY NW
Provider Second Line Business Mailing Address:
SUITE # 202
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-9149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-307-7010
Provider Business Mailing Address Fax Number:
360-307-9170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9395 LINDER WAY NW
Provider Second Line Business Practice Location Address:
SUITE # 202
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98383-9149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-307-7010
Provider Business Practice Location Address Fax Number:
360-307-9170
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEINE
Authorized Official First Name:
CAROLE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
360-307-7010

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH00003850 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084P0800X , with the licence number: 26288 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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