Provider Demographics
NPI:1619020310
Name:SEATTLE CHILDREN'S HOME
Entity Type:Organization
Organization Name:SEATTLE CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PALM
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCSW (NY)
Authorized Official - Phone:206-283-3300
Mailing Address - Street 1:2142 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2845
Mailing Address - Country:US
Mailing Address - Phone:206-283-3300
Mailing Address - Fax:
Practice Address - Street 1:2142 10TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2845
Practice Address - Country:US
Practice Address - Phone:206-283-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA041251S00000X
WA018251S00000X
WARTF-1057322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117377Medicaid
WA029OtherRSN PROVIDER NUMBER
WA1982404Medicaid
WA7092398Medicaid