Provider Demographics
NPI:1215162748
Name:SNOHOMISH HEALTH DISTRICT
Entity type:Organization
Organization Name:SNOHOMISH HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-339-5215
Mailing Address - Street 1:3020 RUCKER AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3900
Mailing Address - Country:US
Mailing Address - Phone:425-339-5215
Mailing Address - Fax:425-339-5263
Practice Address - Street 1:3020 RUCKER AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3900
Practice Address - Country:US
Practice Address - Phone:425-339-5215
Practice Address - Fax:425-339-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7901564Medicaid