Healthcare Provider Details

I. General information

NPI: 1659739373
Provider Name (Legal Business Name): NEIGHBORCARE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1753 NW 56TH ST SUITE 200
SEATTLE WA
98107-5279
US

IV. Provider business mailing address

1200 12TH AVE S SUITE 900
SEATTLE WA
98144-2712
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-5939
  • Fax: 206-782-5934
Mailing address:
  • Phone: 206-548-3102
  • Fax: 206-762-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JANINE CHILDS
Title or Position: CFO
Credential:
Phone: 206-548-3034