Common Contracts
1 similar Client Service Contract contracts
ContractClient Service Contract • October 20th, 2022 • Washington
CLIENT SERVICE CONTRACT Adult Family Home (AFH) DSHS Contract Number:2212-60170Program Contract Number: This Contract is between the State of Washington Department of Social and Health Services (DSHS) and the Contractor identified below. ProviderOne ID and Location Number: CONTRACTOR NAME John J. Smith CONTRACTOR Doing Business As (DBA) Johns Place AFH CONTRACTOR MAILING ADDRESS 1234 12th Ave NEJunction City WA 98333-3333 ADULT FAMILY HOME (AFH) STREET ADDRESS 3421 Main StreetSuite 40-11Aberdeen Junction WA 98333-3333 CONTRACTOR Uniform Business Identifier (UBI) 600-123-123 CONTRACTOR DSHS INDEX NUMBER 146175 AFH LICENSE NUMBER CONTRACTOR CONTACTJohn Smith CONTRACTOR TELEPHONE(360) 555-1212 CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS john@someemail.com DSHS ADMINISTRATION Aging & Long Term Support Admin DSHS DIVISION Division of Home And Community Services DSHS CONTRACT CODE 1080XS-12 DSHS CONTACT NAME AND TITLE Student One Contracts Manager DSHS CONTACT ADDRESS 4500 10th Ave SE Lacey,
