Provider Demographics
NPI:1750065827
Name:DSHS/DDA/FIRCREST SCHOOL
Entity type:Organization
Organization Name:DSHS/DDA/FIRCREST SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-361-3087
Mailing Address - Street 1:15230 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7130
Mailing Address - Country:US
Mailing Address - Phone:206-361-3087
Mailing Address - Fax:
Practice Address - Street 1:15230 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7130
Practice Address - Country:US
Practice Address - Phone:206-361-3087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility