Basic Information
| Provider Information | |||||||||
| NPI: | 1063566867 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS HOME SOCIETY OF WASHINGTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15190 | ||||||||
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| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981150190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066953200 | ||||||||
| FaxNumber: | 2066953201 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 W 12TH STREET | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606951325 | ||||||||
| FaxNumber: | 3606959803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OSBORNE | ||||||||
| AuthorizedOfficialFirstName: | D | ||||||||
| AuthorizedOfficialMiddleName: | SHARON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 2066953200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.