Provider Demographics
NPI:1831847565
Name:COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DION
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPETANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-789-3700
Mailing Address - Street 1:8609 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2619
Mailing Address - Country:US
Mailing Address - Phone:425-789-3700
Mailing Address - Fax:
Practice Address - Street 1:4201 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2215
Practice Address - Country:US
Practice Address - Phone:425-386-4166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-11
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy