Provider Demographics
NPI:1154072734
Name:SENECA FAMILY OF AGENCIES
Entity type:Organization
Organization Name:SENECA FAMILY OF AGENCIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-725-5727
Mailing Address - Street 1:13925 INTERURBAN AVE S STE 120
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5718
Mailing Address - Country:US
Mailing Address - Phone:206-948-0096
Mailing Address - Fax:
Practice Address - Street 1:724 S YAKIMA AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:206-948-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENECA FAMILY OF AGENCIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200242Medicaid