Provider Demographics
NPI:1689294563
Name:NORTH SOUND BEHAVIORAL HEALTH ADMINISTRATIVE SERVICES ORGANIZATION LLC
Entity Type:Organization
Organization Name:NORTH SOUND BEHAVIORAL HEALTH ADMINISTRATIVE SERVICES ORGANIZATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER/PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DEELENA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA, CPHQ
Authorized Official - Phone:360-416-7013
Mailing Address - Street 1:301 VALLEY MALL WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5462
Mailing Address - Country:US
Mailing Address - Phone:360-416-7013
Mailing Address - Fax:
Practice Address - Street 1:301 VALLEY MALL WAY STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5462
Practice Address - Country:US
Practice Address - Phone:360-416-7013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA105020903Medicaid