Healthcare Provider Details

I. General information

NPI: 1164986063
Provider Name (Legal Business Name): PIONEER HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S 9TH ST
TACOMA WA
98402-3625
US

IV. Provider business mailing address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-3462
  • Fax: 253-383-2097
Mailing address:
  • Phone: 206-766-7006
  • Fax: 206-768-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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