Provider Demographics
NPI:1952809857
Name:COMMUNITY CARE LLC
Entity Type:Organization
Organization Name:COMMUNITY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:206-937-4217
Mailing Address - Street 1:5424 DELRIDGE WAY SW UNIT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1439
Mailing Address - Country:US
Mailing Address - Phone:206-937-4217
Mailing Address - Fax:206-937-6176
Practice Address - Street 1:5424 DELRIDGE WAY SW UNIT A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1439
Practice Address - Country:US
Practice Address - Phone:206-937-4217
Practice Address - Fax:206-937-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1118454Medicaid