| NPI | 1457987752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY BARTOLO Credentialing Specialist 206-788-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-02-26 |