Provider Demographics
NPI:1992870208
Name:SEA MAR COMMUNITY HEALTH CENTERS
Entity type:Organization
Organization Name:SEA MAR COMMUNITY HEALTH CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-428-8912
Mailing Address - Street 1:1031 SE EVERETT MALL WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-2833
Mailing Address - Country:US
Mailing Address - Phone:425-609-5505
Mailing Address - Fax:425-609-5506
Practice Address - Street 1:1031 SE EVERETT MALL WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2833
Practice Address - Country:US
Practice Address - Phone:425-609-5505
Practice Address - Fax:425-609-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health