Provider Demographics
NPI:1588869093
Name:PIERCE COUNTY ALLIANCE
Entity type:Organization
Organization Name:PIERCE COUNTY ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NEISWENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-502-5403
Mailing Address - Street 1:510 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5416
Mailing Address - Country:US
Mailing Address - Phone:253-572-4750
Mailing Address - Fax:253-272-6788
Practice Address - Street 1:510 TACOMA AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5416
Practice Address - Country:US
Practice Address - Phone:253-572-4750
Practice Address - Fax:253-272-6788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA27019101251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1990647Medicaid