Provider Demographics
NPI:1629362108
Name:PIERCE COUNTY ALLIANCE
Entity Type:Organization
Organization Name:PIERCE COUNTY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEISWENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-502-5403
Mailing Address - Street 1:510 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5416
Mailing Address - Country:US
Mailing Address - Phone:253-502-5403
Mailing Address - Fax:253-272-6788
Practice Address - Street 1:2000 LAKERIDGE DR. SW
Practice Address - Street 2:BLDG. 2 THURSTON COUNTY DRUG COURT
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-357-2482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34140400261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1588869093Medicaid