Provider Demographics
NPI:1558603431
Name:FEDERAL DETENTION CENTER SEATAC
Entity Type:Organization
Organization Name:FEDERAL DETENTION CENTER SEATAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ITURRALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-870-5740
Mailing Address - Street 1:2425 S 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5202
Mailing Address - Country:US
Mailing Address - Phone:206-870-5700
Mailing Address - Fax:
Practice Address - Street 1:2425 S 200TH ST
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98198-5202
Practice Address - Country:US
Practice Address - Phone:206-870-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEDERAL BUREAU OF PRISONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare