Healthcare Provider Details

I. General information

NPI: 1942494133
Provider Name (Legal Business Name): SEA-MAR COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 14TH AVE S
SEATTLE WA
98108-4809
US

IV. Provider business mailing address

4455 CORDATA PKWY
BELLINGHAM WA
98226-8037
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-0491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number6 H80CS00 455-05-03
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6 H80CS00 455-05-03
License Number StateWA

VIII. Authorized Official

Name: MR. ROGELIO RIOJAS
Title or Position: CEO
Credential:
Phone: 206-763-5277