Healthcare Provider Details

I. General information

NPI: 1932346764
Provider Name (Legal Business Name): SEA-MAR COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14434 AMBAUM BLVD SW SUITE 5
BURIEN WA
98166-1438
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 206-812-6140
  • Fax: 206-812-6177
Mailing address:
  • Phone: 206-764-3335
  • Fax: 206-764-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number600-537-278-1
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number600 537 278 1
License Number StateWA

VIII. Authorized Official

Name: ROGELIO RIOJAS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-788-3226