=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215358676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUNG WOMENS CHRISTIAN ASSOCIATION OF SEATTLE KING COUNTY SNOHOMIS COU
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2014
-----------------------------------------------------
Last Update Date | 01/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19703 68TH AVENUE WEST
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-412-2360
-----------------------------------------------------
Fax | 425-412-2379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1118 5TH AVE
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98101-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-461-4888
-----------------------------------------------------
Fax | 206-461-4453
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MS. SUSAN D. SHERBROOKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-461-4851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 287
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 249
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 249
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 287
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------