Healthcare Provider Details

I. General information

NPI: 1114782414
Provider Name (Legal Business Name): PEOPLE OF COLOR AGAINST AIDS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S 336TH ST STE 330
FEDERAL WAY WA
98003-7354
US

IV. Provider business mailing address

1010 S 336TH ST STE 330
FEDERAL WAY WA
98003-7354
US

V. Phone/Fax

Practice location:
  • Phone: 206-653-9353
  • Fax: 206-934-1515
Mailing address:
  • Phone: 206-653-9353
  • Fax: 206-934-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS L PORTER
Title or Position: HEALTHCARE MANAGER
Credential:
Phone: 206-653-9353