Provider Demographics
NPI:1013328400
Name:THE MOORE CENTER, PC
Entity Type:Organization
Organization Name:THE MOORE CENTER, PC
Other - Org Name:EATING RECOVERY CENTER OF WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING & CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-383-4781
Mailing Address - Street 1:1231 116TH AVE NE
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6950
Mailing Address - Country:US
Mailing Address - Phone:425-454-1010
Mailing Address - Fax:425-451-8501
Practice Address - Street 1:1231 116TH AVE NE
Practice Address - Street 2:8TH FLOOR
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3804
Practice Address - Country:US
Practice Address - Phone:425-454-1010
Practice Address - Fax:425-451-8501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MOORE CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-19
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 261QM0850X, 261QM0855X
WARTF.FS.60450314323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health