Provider Demographics
NPI: | 1700925351 |
---|---|
Name: | MULTICARE HEALTH SYSTEM |
Entity Type: | Organization |
Organization Name: | MULTICARE HEALTH SYSTEM |
Other - Org Name: | MULTICARE BEHAVIORAL HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | RECRUITING ASSOCIATE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LORI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VANDERBUSH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 253-403-7726 |
Mailing Address - Street 1: | 325 E. PIONEER |
Mailing Address - Street 2: | |
Mailing Address - City: | PUYALLUP |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98372-3265 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-697-8548 |
Mailing Address - Fax: | 253-697-8598 |
Practice Address - Street 1: | 325 E. PIONEER |
Practice Address - Street 2: | |
Practice Address - City: | PUYALLUP |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98372-3265 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-697-8548 |
Practice Address - Fax: | 253-697-8598 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-06 |
Last Update Date: | 2015-06-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103G00000X, 103T00000X, 103TC2200X, 103TF0000X, 103TM1800X, 103TP0016X, 103TR0400X, 1041C0700X, 2084N0600X, 2084P0800X, 2084P0802X, 2084P0805X, 251B00000X, 261QR0405X | ||
WA | 051 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2084N0600X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2084P0802X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | Group - Multi-Specialty |
No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |