Provider Demographics
NPI:1053400077
Name:THERAPEUTIC HEALTH SERVICES
Entity type:Organization
Organization Name:THERAPEUTIC HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-323-0930
Mailing Address - Street 1:5802 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2706
Mailing Address - Country:US
Mailing Address - Phone:206-723-1980
Mailing Address - Fax:
Practice Address - Street 1:1305 SENECA ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2828
Practice Address - Country:US
Practice Address - Phone:206-323-0930
Practice Address - Fax:206-323-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1994086Medicaid