Healthcare Provider Details

I. General information

NPI: 1073554671
Provider Name (Legal Business Name): PUBLIC HOSPITAL DISTRICT #1 OF KING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 TALBOT RD S
RENTON WA
98055-6219
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100
RENTON WA
98057-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-4055
  • Fax: 425-656-5425
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-5423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BERNSTEIN
Title or Position: CFO
Credential:
Phone: 425-656-5536