Provider Demographics
NPI:1578593562
Name:NEIGHBORCARE HEALTH
Entity Type:Organization
Organization Name:NEIGHBORCARE HEALTH
Other - Org Name:PUGET SOUND NEIGHBORHOOD HEALTH CENTERS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-461-6935
Mailing Address - Street 1:1200 12TH AVE SOUTH
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:1200 12TH AVE S STE 901
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2712
Practice Address - Country:US
Practice Address - Phone:206-461-6935
Practice Address - Fax:206-461-8382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7401953Medicaid
WA7034176Medicaid
WA32120OtherL&I
WA7401953Medicaid
WA501803Medicare PIN