NPIMap

Organization Active NPI

Center for Human Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Shoreline, WA
National Provider Identifier
1053498220
Registry record updated Sep 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
17015900 Issued in WA
Legal business name
CENTER FOR HUMAN SERVICES
Practice address
17018 15TH Ave NE
Shoreline, WA 98155-5126
Phone
(206) 362-7282
Fax
(206) 362-7152
NPI assigned
Nov 1, 2006
Last updated
Sep 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Beratta GomillionNPI 1972942787
Title
Executive Director
Phone
(206) 362-7282

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 17015900 WA
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 154 WA
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 17015900 WA Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Community/Behavioral Health Agency 251S00000X 17015900 WA

Addresses

Primary practice location

17018 15TH Ave NE
Shoreline, WA 98155-5126

Mailing address

17018 15TH Ave NE
Shoreline, WA 98155-5126
Phone (206) 362-7282

Other identifiers 1

IdentifierTypeStateIssuer
1990308MedicaidWA

Other names 1

  • CHS Shoreline 170th Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2245248Center for Human Services17018 15TH Ave NE, Shoreline, WA 98155Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Center for Human Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

17018 15th Ave NE
Shoreline, WA 98155
Phone (206) 369-1224

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474070400000",
    "number": "1053498220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17018 15TH AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981555126",
            "telephone_number": "206-362-7282",
            "fax_number": "206-362-7152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17018 15TH AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981555126",
            "telephone_number": "206-362-7282",
            "fax_number": "206-362-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR HUMAN SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2016-09-17",
        "status": "A",
        "authorized_official_last_name": "GOMILLION",
        "authorized_official_first_name": "BERATTA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "206-362-7282"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WA",
            "license": "17015900",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WA",
            "license": "154",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "WA",
            "license": "17015900",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "17015900",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1990308",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHS Shoreline 170th",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.