Healthcare Provider Details

I. General information

NPI: 1831847565
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RUCKER AVE
EVERETT WA
98203-2215
US

IV. Provider business mailing address

8609 EVERGREEN WAY
EVERETT WA
98208-2619
US

V. Phone/Fax

Practice location:
  • Phone: 425-386-4166
  • Fax:
Mailing address:
  • Phone: 425-789-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DION KAPETANOV
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 425-789-3700