Provider Demographics
NPI:1902562333
Name:AMFM HEALTHCARE WASHINGTON
Entity Type:Organization
Organization Name:AMFM HEALTHCARE WASHINGTON
Other - Org Name:MISSION CONNECTION HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-424-9921
Mailing Address - Street 1:30310 RANCHO VIEJO RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1576
Mailing Address - Country:US
Mailing Address - Phone:206-558-5479
Mailing Address - Fax:949-579-2876
Practice Address - Street 1:6990 E GREEN LAKE WAY N
Practice Address - Street 2:SUITE G
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115
Practice Address - Country:US
Practice Address - Phone:206-558-5479
Practice Address - Fax:949-579-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABHA.FS.61272048OtherWASHINGTON STATE DEPARTMENT OF HEALTH
WA578314OtherTHE JOINT COMMISSION