Provider Demographics
NPI:1578686630
Name:UNIVERSITY OF WASHINGTON PARENT-CHILD ASSISTANCE PROGRAM
Entity Type:Organization
Organization Name:UNIVERSITY OF WASHINGTON PARENT-CHILD ASSISTANCE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WASHINGTON STATE PCAP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:206-543-7155
Mailing Address - Street 1:180 NICKERSON ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1631
Mailing Address - Country:US
Mailing Address - Phone:206-543-7155
Mailing Address - Fax:206-685-2903
Practice Address - Street 1:180 NICKERSON ST
Practice Address - Street 2:SUITE 309
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1631
Practice Address - Country:US
Practice Address - Phone:206-543-7155
Practice Address - Fax:206-685-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7408313Medicaid
WA7406911Medicaid
WA8030132OtherSUBMITTER ID NUMBER