Provider Demographics
NPI:1720291032
Name:NEIGHBORCARE HEALTH
Entity Type:Organization
Organization Name:NEIGHBORCARE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SECORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-461-6935
Mailing Address - Street 1:905 SPRUCE ST
Mailing Address - Street 2:STE. 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2474
Mailing Address - Country:US
Mailing Address - Phone:206-461-6935
Mailing Address - Fax:206-461-8382
Practice Address - Street 1:9245 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4655
Practice Address - Country:US
Practice Address - Phone:206-722-8444
Practice Address - Fax:206-721-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7901242Medicaid