Provider Demographics
NPI:1508321761
Name:SEA - MAR COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SEA - MAR COMMUNITY HEALTH CENTER
Other - Org Name:CSNW BATTLEGROUND
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOLEE
Authorized Official - Middle Name:ANN ELIZABETH
Authorized Official - Last Name:SANKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-474-2001
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-3335
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:11117 NE 189TH ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-6244
Practice Address - Country:US
Practice Address - Phone:206-474-2001
Practice Address - Fax:206-764-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder