Healthcare Provider Details

I. General information

NPI: 1457769580
Provider Name (Legal Business Name): PIONEER HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S POST ST
SPOKANE WA
99201-4423
US

IV. Provider business mailing address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-1999
  • Fax: 509-624-3980
Mailing address:
  • Phone: 206-768-1990
  • Fax: 206-768-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2125
License Number StateWA

VIII. Authorized Official

Name: VICKI RUSH
Title or Position: CONTRACT ADMINISTRATOR
Credential:
Phone: 206-766-7006