Provider Demographics
NPI:1235521014
Name:SEATTLE CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:SEATTLE CHILDREN'S HOSPITAL
Other - Org Name:SEATTLE CHILDREN'S ALYSSA BURNETT ADULT LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-987-2004
Mailing Address - Street 1:19213 BOTHELL WAY NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2939
Mailing Address - Country:US
Mailing Address - Phone:425-488-6173
Mailing Address - Fax:
Practice Address - Street 1:19213 BOTHELL WAY NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2939
Practice Address - Country:US
Practice Address - Phone:425-488-6173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEATTLE CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA178019356251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services