Provider Demographics
NPI:1376984203
Name:PIONEER HUMAN SERVICES
Entity Type:Organization
Organization Name:PIONEER HUMAN SERVICES
Other - Org Name:CO-OCCURRING RESIDENTIAL PRGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSCOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-768-1990
Mailing Address - Street 1:7440 W MARGINAL WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4141
Mailing Address - Country:US
Mailing Address - Phone:206-768-1990
Mailing Address - Fax:206-768-8910
Practice Address - Street 1:505 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-5709
Practice Address - Country:US
Practice Address - Phone:253-856-1825
Practice Address - Fax:253-856-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17128100324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility