Healthcare Provider Details

I. General information

NPI: 1568931525
Provider Name (Legal Business Name): SEA-MAR COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 15TH AVE SW
SEATTLE WA
98106-2820
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 206-965-1055
  • Fax: 206-965-1032
Mailing address:
  • Phone: 206-474-2001
  • Fax: 206-764-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOLEE ANN ELIZABETH SANKEY
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 206-474-2001