Organization
PHD#2 OF SNOHOMISH COUNTY
Active
Organization
PHD#2 OF SNOHOMISH COUNTY
Active
Parent organization
PHD#2 OF SNOHOMISH COUNTY
Other names
Stevens Hospital, Stevens Memorial Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHD#2 OF SNOHOMISH COUNTY
Authorized official
MR. GARY WANGSMO (CFO)
(425) 640-4113
Entity
Organization
Contact information
Practice address
21601 76TH AVE W, EDMONDS, WA 98026-7507
(425) 640-4000
(425) 640-4432
Mailing address
21601 76TH AVE W, EDMONDS, WA 98026-7507
(425) 640-4000
(425) 640-4432
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
H-138
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0065668
AETNA
WA
01
—
0288
REGENCE BLUE SHIELD
WA
01
—
11031
WA DEPT OF L&I
WA
01
—
150
PREMERA BLUE CROSS
WA
05
—
3500071
—
WA
01
—
6580520
AETNA
WA
01
—
HP150
PREMERA BLUE CROSS
WA
01
—
MC150
PREMERA BLUE CROSS
WA
01
—
ST0092
REGENCE BLUE SHIELD
WA
01
—
W718582
CHAMPUS
WA
Enumeration date
10/13/2005
Last updated
08/28/2007
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