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1550 North 115th Street Mail Stop Pz 506 Seattle WA 98133-9733 | |
| (206) 364-0500 | |
| (206) 368-3029 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1550 North 115th Street, Seattle, Washington |
| Authorized Official Name and Position | Bruce Ferguson (VP/CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2063681700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1550 North 115th Street Seattle WA 98133-9733 Ph: (206) 364-0500 | 1550 North 115th Street Mail Stop Pz 506 Seattle WA 98133-9733 Ph: (206) 364-0500 |
| NPI Number | 1497766067 |
|---|---|
| Provider Enumeration Date | 08/10/2006 |
| Last Update Date | 12/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497766067 | NPI | - | NPPES |
| 3500220 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Secondary |
| 273R00000X | Psychiatric Unit | H-130HAC.FS.00000130 (Washington) | Primary |
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