1891343075 NPI number — SEATTLE ROOTS COMMUNITY HEALTH

Table of content: (NPI 1891343075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891343075 NPI number — SEATTLE ROOTS COMMUNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEATTLE ROOTS COMMUNITY HEALTH
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:
1891343075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 E YESLER WAY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122-5959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-709-7112
Provider Business Mailing Address Fax Number:
206-299-1920

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1621 S JACKSON ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98144-2277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-732-0311
Provider Business Practice Location Address Fax Number:
206-299-0855
Provider Enumeration Date:
08/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
TREPTOW
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM DIRECTOR OF FINANCE
Authorized Official Telephone Number:
206-299-1937

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; 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: UBI601583685 . This is a "DEPARTMENT OF REVENUE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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