Healthcare Provider Details

I. General information

NPI: 1578593562
Provider Name (Legal Business Name): NEIGHBORCARE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 12TH AVE S STE 901
SEATTLE WA
98144-2712
US

IV. Provider business mailing address

1200 12TH AVE SOUTH SUITE 901
SEATTLE WA
98144
US

V. Phone/Fax

Practice location:
  • Phone: 206-461-6935
  • Fax: 206-461-8382
Mailing address:
  • Phone: 206-548-3114
  • Fax: 206-762-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ERIKSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 206-461-6935