Provider Demographics
NPI:1053290627
Name:CHIEF SEATTLE CLUB
Entity type:Organization
Organization Name:CHIEF SEATTLE CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-960-4279
Mailing Address - Street 1:410 2ND AVENUE EXT S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2876
Mailing Address - Country:US
Mailing Address - Phone:206-715-7536
Mailing Address - Fax:
Practice Address - Street 1:410 2ND AVENUE EXT S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2876
Practice Address - Country:US
Practice Address - Phone:206-715-7536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health