Provider Demographics
NPI:1023197795
Name:CENTER FOR HUMAN SERVICES
Entity Type:Organization
Organization Name:CENTER FOR HUMAN SERVICES
Other - Org Name:CHS SCRIBER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-362-7282
Mailing Address - Street 1:17018 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5126
Mailing Address - Country:US
Mailing Address - Phone:206-362-7282
Mailing Address - Fax:206-362-7152
Practice Address - Street 1:23200 100TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5020
Practice Address - Country:US
Practice Address - Phone:425-431-5825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1994029Medicaid