Provider Demographics
NPI:1295925626
Name:SHORELINE COMMUNITY COLLEGE
Entity type:Organization
Organization Name:SHORELINE COMMUNITY COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING VICE PRESIDENT FOR ADMINISTR
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:A T
Authorized Official - Last Name:TRIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-546-4532
Mailing Address - Street 1:16101 GREENWOOD AVE N
Mailing Address - Street 2:BLDG #2500
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-5696
Mailing Address - Country:US
Mailing Address - Phone:206-546-4711
Mailing Address - Fax:206-546-5830
Practice Address - Street 1:16101 GREENWOOD AVE N
Practice Address - Street 2:BLDG #2500
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-5696
Practice Address - Country:US
Practice Address - Phone:206-546-4711
Practice Address - Fax:206-546-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental