Basic Information
| Provider Information | |||||||||
| NPI: | 1194069427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PIONEER HUMAN SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7440 W MARGINAL WAY S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981084141 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 VIRGINIA ST | ||||||||
| Address2: | STE 210 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981011439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064703856 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2012 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | GROSCOST | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2067667015 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 160 | WA | N | Agencies | Community/Behavioral Health | 261QM0850X | 160 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0801X | 160 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 1995083 | 05 | WA | MEDICAID |