Provider Demographics
NPI:1215242235
Name:UNITED COMMUNITIES AIDS NETWORK
Entity type:Organization
Organization Name:UNITED COMMUNITIES AIDS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-352-2375
Mailing Address - Street 1:317 4TH AVE E STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1117
Mailing Address - Country:US
Mailing Address - Phone:360-352-2375
Mailing Address - Fax:360-352-1494
Practice Address - Street 1:317 4TH AVE E STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1117
Practice Address - Country:US
Practice Address - Phone:360-352-2375
Practice Address - Fax:360-352-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601019612302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization