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General NPI Number Information
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NPI Number | 1023006061
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Entity Type | Organization
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Legal Business Name | PHD#2 OF SNOHOMISH COUNTY
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 08/28/2007
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Provider Practice Location Address
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Address Line | 21601 76TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-7507
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Country | US
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Telephone | 425-640-4000
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Fax | 425-640-4432
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Provider Business Mailing Address
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Address Line | 21601 76TH AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-7507
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Country | US
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Telephone | 425-640-4000
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Fax | 425-640-4432
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Authorized Official
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Title or Position | CFO
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Name | MR. GARY WANGSMO
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Credential |
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Telephone | 425-640-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | H-138
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License Number State | WA
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