Basic Information
| Provider Information | |||||||||
| NPI: | 1558825620 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| 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 | ||||||||
| TelephoneNumber: | 2067667006 | ||||||||
| FaxNumber: | 2067688910 | ||||||||
| Practice Location | |||||||||
| Address1: | 1011 DIGBY RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982749165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603360116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2019 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | WOOLWORTH | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP TREATMENT & RECOVERY SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 2067667018 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 177F00000X | N | Other Service Providers | Lodging | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.