Basic Information
| Provider Information | |||||||||
| NPI: | 1003201732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PIONEER HUMAN SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WHATCOM COMMUNITY DETOX | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24961 THOMPSON DR | ||||||||
| Address2: | |||||||||
| City: | SEDRO WOOLLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982848246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608563108 | ||||||||
| FaxNumber: | 3608563138 | ||||||||
| Practice Location | |||||||||
| Address1: | 2030 DIVISION ST STE B | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982268014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606762020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILLIS | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3608563108 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | RTF.FS00001081 | WA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.