Provider Demographics
NPI:1598103624
Name:CENTER FOR HUMAN SERVICES
Entity Type:Organization
Organization Name:CENTER FOR HUMAN SERVICES
Other - Org Name:CHS NORTHSHORE 103RD
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERATTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMILLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-362-7282
Mailing Address - Street 1:17018 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5126
Mailing Address - Country:US
Mailing Address - Phone:206-362-7282
Mailing Address - Fax:206-362-7152
Practice Address - Street 1:18414 103RD AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3410
Practice Address - Country:US
Practice Address - Phone:206-362-7282
Practice Address - Fax:206-362-7152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR HUMAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-11
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA17153800251B00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251B00000XAgenciesCase Management