Healthcare Provider Details

I. General information

NPI: 1649592130
Provider Name (Legal Business Name): PIONEER HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 WASHINGTON AVE S
KENT WA
98032-5709
US

IV. Provider business mailing address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

V. Phone/Fax

Practice location:
  • Phone: 253-856-1825
  • Fax: 253-856-2457
Mailing address:
  • Phone: 206-768-1990
  • Fax: 206-768-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number17128100
License Number StateWA

VIII. Authorized Official

Name: MRS. TRACEY GROSCOST
Title or Position: CFO
Credential:
Phone: 206-768-1990