Basic Information
| Provider Information | |||||||||
| NPI: | 1265950521 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEA - MAR COMMUNITY HEALTH CENTER | ||||||||
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| OtherOrganizationName: | SEA-MAR COMMUNITY HEALTH WHITE CENTER BH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34703 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241703 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9650 15TH AVE SW # 100 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981062820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069651000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 04/26/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOESHEN | ||||||||
| AuthorizedOfficialFirstName: | KRISTINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATION DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2067883203 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM2500X | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 261QR0405X | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 1008573 | 05 | WA | MEDICAID |