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General NPI Number Information
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NPI Number | 1750634275
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Entity Type | Organization
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Legal Business Name | CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 10/15/2018
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Provider Practice Location Address
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Address Line | 100 23RD AVE S
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City | SEATTLE
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State | WA
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Zip | 98144-2302
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Country | US
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Telephone | 206-328-5771
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Fax |
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Provider Business Mailing Address
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Address Line | 2313 3RD AVE
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City | SEATTLE
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State | WA
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Zip | 98121-1711
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Country | US
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Telephone | 206-328-5771
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE & POLICY ANALYST
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Name | STEPHANIE M. THELEN
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Credential |
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Telephone | 253-761-3898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 17138600
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License Number State | WA
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