=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366819898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAVOS MENTAL HEALTH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2015
-----------------------------------------------------
Last Update Date | 09/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1210 SW 136TH ST
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98166-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-248-8226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1210 SW 136TH ST
-----------------------------------------------------
City | BURIEN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98166-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-248-8226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CASE MANAGER
-----------------------------------------------------
Name | MR. HONG SEOB JEONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-651-8072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------