Provider Demographics
NPI: | 1841741311 |
---|---|
Name: | MULTICARE HEALTH SYSTEM |
Entity Type: | Organization |
Organization Name: | MULTICARE HEALTH SYSTEM |
Other - Org Name: | ADOLESCENT BEHAVIORAL HEALTH AT TACOMA GENERAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | GLENN |
Authorized Official - Last Name: | ROBERTSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 253-403-1272 |
Mailing Address - Street 1: | P.O. BOX 5299 |
Mailing Address - Street 2: | MS: 820-5-PCO |
Mailing Address - City: | TACOMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98415-0299 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 315 MARTIN LUTHER KING JR WAY |
Practice Address - Street 2: | |
Practice Address - City: | TACOMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98405-4234 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-403-0556 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-10-20 |
Last Update Date: | 2023-08-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 601100682 | 273R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 273R00000X | Hospital Units | Psychiatric Unit |