Healthcare Provider Details

I. General information

NPI: 1558825620
Provider Name (Legal Business Name): PIONEER HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 DIGBY RD
MOUNT VERNON WA
98274-9165
US

IV. Provider business mailing address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-0116
  • Fax:
Mailing address:
  • Phone: 206-766-7006
  • Fax: 206-768-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN WOOLWORTH
Title or Position: VP TREATMENT & RECOVERY SERVICES
Credential:
Phone: 206-766-7018