Healthcare Provider Details

I. General information

NPI: 1598103624
Provider Name (Legal Business Name): CENTER FOR HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18414 103RD AVE NE
BOTHELL WA
98011-3410
US

IV. Provider business mailing address

17018 15TH AVE NE
SHORELINE WA
98155-5126
US

V. Phone/Fax

Practice location:
  • Phone: 206-362-7282
  • Fax: 206-362-7152
Mailing address:
  • Phone: 206-362-7282
  • Fax: 206-362-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number17153800
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number17153800
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BERATTA GOMILLION
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-362-7282