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General NPI Number Information
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NPI Number | 1851115505
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Entity Type | Organization
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Legal Business Name | BISON HEALTH LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 401 OLYMPIA AVE NE STE 353
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City | RENTON
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State | WA
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Zip | 98056-4117
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Country | US
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Telephone | 206-948-2582
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18711
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City | SEATTLE
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State | WA
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Zip | 98118-0711
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Country | US
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Telephone | 206-948-2582
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | STACEY LEE MERTES
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Credential |
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Telephone | 206-948-2582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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