Basic Information
| Provider Information | |||||||||
| NPI: | 1689294563 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SOUND BEHAVIORAL HEALTH ADMINISTRATIVE SERVICES ORGANIZATION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 VALLEY MALL WAY STE 110 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982735462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604167013 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 VALLEY MALL WAY STE 110 | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982735462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604167013 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2020 | ||||||||
| LastUpdateDate: | 04/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | DEELENA | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPLIANCE OFFICER/PROJECT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3604167013 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA, MHA, CPHQ | ||||||||
| NPICertificationDate: | 04/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | N | Managed Care Organizations | Health Maintenance Organization | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 105020903 | 05 | WA | MEDICAID |