Provider Demographics
NPI: | 1831313253 |
---|---|
Name: | MULTICARE HEALTH SYSTEM |
Entity Type: | Organization |
Organization Name: | MULTICARE HEALTH SYSTEM |
Other - Org Name: | MARY BRIDGE NEURODEVELOPMENTAL PROGRAM |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VINCE |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | SCHMITZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 253-459-8000 |
Mailing Address - Street 1: | 311 S L ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TACOMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98405-3720 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-403-3707 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 311 S L ST |
Practice Address - Street 2: | |
Practice Address - City: | TACOMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98405-3720 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-403-3707 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-13 |
Last Update Date: | 2010-05-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | |
No | 261QE0002X | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care | |
No | 261QG0250X | Ambulatory Health Care Facilities | Clinic/Center | Genetics | |
No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service | |
No | 261QH0700X | Ambulatory Health Care Facilities | Clinic/Center | Hearing and Speech | |
No | 261QI0500X | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | |
No | 261QX0100X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 7134133 | Medicaid |