Healthcare Provider Details

I. General information

NPI: 1265982599
Provider Name (Legal Business Name): CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5410 N 44TH ST
TACOMA WA
98407-3715
US

IV. Provider business mailing address

1001 N J ST
TACOMA WA
98403-2125
US

V. Phone/Fax

Practice location:
  • Phone: 253-761-3898
  • Fax:
Mailing address:
  • Phone: 532-761-3829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number76-122
License Number StateWA

VIII. Authorized Official

Name: MOLLY A QUINLAN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 62-940-9640