Basic Information
| Provider Information | |||||||||
| NPI: | 1912563883 | ||||||||
| 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: | 1960 THOMPSON DR | ||||||||
| Address2: | |||||||||
| City: | SEDRO WOOLLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982845007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608563186 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2019 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | RUSH | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACTS ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2067667006 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.