Provider Demographics
NPI:1215002365
Name:SEATTLE INDIAN HEALTH BOARD
Entity Type:Organization
Organization Name:SEATTLE INDIAN HEALTH BOARD
Other - Org Name:THUNDERBIRD TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORQUERA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:206-324-9360
Mailing Address - Street 1:PO BOX 3364
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-3364
Mailing Address - Country:US
Mailing Address - Phone:206-324-9360
Mailing Address - Fax:206-324-8910
Practice Address - Street 1:9236 RENTON AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5322
Practice Address - Country:US
Practice Address - Phone:206-324-9360
Practice Address - Fax:206-324-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0024817002 BLSEATTLE324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA005701OtherTARGET
WA051276747OtherALCOHOL AND SUBSTACE ABUS