Healthcare Provider Details

I. General information

NPI: 1730513805
Provider Name (Legal Business Name): COMMUNITY HEALTH PLAN OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 3RD AVE STE 400
SEATTLE WA
98101-3207
US

IV. Provider business mailing address

1111 3RD AVE STE 400
SEATTLE WA
98101-3207
US

V. Phone/Fax

Practice location:
  • Phone: 206-521-8833
  • Fax: 206-521-8834
Mailing address:
  • Phone: 206-521-8833
  • Fax: 206-521-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number601727749
License Number StateWA

VIII. Authorized Official

Name: ALAN LEDERMAN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 206-515-4704