Basic Information
| Provider Information | |||||||||
| NPI: | 1518203785 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PIONEER HUMAN SERVICES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CO-OCCURRING RESIDENTIAL PROGRAM | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7440 W. MARGINAL WAY S. | ||||||||
| Address2: | PIONEER HUMAN SERVICES - CONTRACTS | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981084141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067681990 | ||||||||
| FaxNumber: | 2067688910 | ||||||||
| Practice Location | |||||||||
| Address1: | 11900 BEACON AVENUE S. | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067726900 | ||||||||
| FaxNumber: | 2067726566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2012 | ||||||||
| LastUpdateDate: | 10/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | WOOLWORTH | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, TREATMENT & REENTRY | ||||||||
| AuthorizedOfficialTelephone: | 2067667018 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 17128100 | WA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.