Provider Demographics
NPI:1114782414
Name:PEOPLE OF COLOR AGAINST AIDS NETWORK
Entity Type:Organization
Organization Name:PEOPLE OF COLOR AGAINST AIDS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-653-9353
Mailing Address - Street 1:901 RAINIER AVE N STE B203
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5376
Mailing Address - Country:US
Mailing Address - Phone:206-653-9353
Mailing Address - Fax:206-934-1515
Practice Address - Street 1:901 RAINIER AVE N STE B203
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5376
Practice Address - Country:US
Practice Address - Phone:206-653-9353
Practice Address - Fax:206-934-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7408800Medicaid