Provider Demographics
NPI:1659739373
Name:NEIGHBORCARE HEALTH
Entity Type:Organization
Organization Name:NEIGHBORCARE HEALTH
Other - Org Name:BALLARD HOMELESS DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-548-3034
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3102
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:1753 NW 56TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5279
Practice Address - Country:US
Practice Address - Phone:206-782-5939
Practice Address - Fax:206-782-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)