1801359112 NPI number — UNITY CARE NORTHWEST

Table of content: (NPI 1801359112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801359112 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:
1801359112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2024
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:
360-788-2682
Provider Business Mailing Address Fax Number:
360-594-6982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6060 PORTAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98248-7833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-752-7408
Provider Business Practice Location Address Fax Number:
360-594-3440
Provider Enumeration Date:
04/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
BONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
360-676-6177

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2127891 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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