Provider Demographics
NPI:1962754713
Name:NEIGHBORCARE HEALTH
Entity type:Organization
Organization Name:NEIGHBORCARE HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-461-6935
Mailing Address - Street 1:1200 12TH AVE SOUTH
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:12721 30TH AVE NE
Practice Address - Street 2:STE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4498
Practice Address - Country:US
Practice Address - Phone:206-417-0326
Practice Address - Fax:206-417-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA501965OtherCMS CERTIFICATION
WA501965OtherCMS CERTIFICATION