Healthcare Provider Details

I. General information

NPI: 1518364413
Provider Name (Legal Business Name): SEA MAR COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 FRYELANDS BLVD SE SUITE 347
MONROE WA
98272-2693
US

IV. Provider business mailing address

14090 FRYELANDS BLVD SE SUITE 347
MONROE WA
98272-2693
US

V. Phone/Fax

Practice location:
  • Phone: 360-805-3122
  • Fax: 360-805-9180
Mailing address:
  • Phone: 360-805-3122
  • Fax: 360-805-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60521671
License Number StateWA

VIII. Authorized Official

Name: PAOLA MERCEDES SALDANA
Title or Position: CASE MANAGER
Credential:
Phone: 360-805-3122