Provider Demographics
NPI:1033511951
Name:METROPOLITAN DEVELOPMENT COUNCIL
Entity Type:Organization
Organization Name:METROPOLITAN DEVELOPMENT COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:P
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PEREBOOM
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:253-591-0113
Mailing Address - Street 1:945 FAWCETT AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5612
Mailing Address - Country:US
Mailing Address - Phone:253-383-3921
Mailing Address - Fax:253-593-2400
Practice Address - Street 1:945 FAWCETT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5612
Practice Address - Country:US
Practice Address - Phone:253-383-3921
Practice Address - Fax:253-593-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600528267261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1730206202Medicare NSC
WA1235255092Medicare NSC
WA1760622195Medicare Oscar/Certification
WA1285757450Medicare NSC
WA1548387004Medicare NSC