Basic Information
| Provider Information | |||||||||
| NPI: | 1619149978 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VAPSHCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | VAPSHCS S-116 MIRECC | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067621010 | ||||||||
| FaxNumber: | 2067642476 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | VAPSHCS S-116 MIRECC | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067621010 | ||||||||
| FaxNumber: | 2067642476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2008 | ||||||||
| LastUpdateDate: | 03/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | RASKIND | ||||||||
| AuthorizedOfficialFirstName: | MURRAY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, MENTAL HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 2062773797 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | PSY 2044 | WA | Y | Hospitals | General Acute Care Hospital |
No ID Information.