Provider Demographics
NPI:1023201076
Name:SEA MAR COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:SEA MAR COMMUNITY HEALTH CENTERS
Other - Org Name:SEA MAR CHC MT VERNON SUD - COLLEGE WAY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROGELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-763-5277
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:1010 E COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5624
Practice Address - Country:US
Practice Address - Phone:360-428-8912
Practice Address - Fax:360-424-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6 H80CS00 455-05-03261QF0400X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1054570Medicaid