Healthcare Provider Details

I. General information

NPI: 1790969509
Provider Name (Legal Business Name): HARBORVIEW MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9671
  • Fax: 206-744-9920
Mailing address:
  • Phone: 206-744-9671
  • Fax: 206-744-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRC00017782
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberRC00017782
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License NumberRC00017782
License Number StateWA

VIII. Authorized Official

Name: MR. RON BLUNK
Title or Position: ADMINISTRATOR
Credential: MSW
Phone: 206-744-9690