Provider Demographics
NPI:1679765226
Name:KITSAP COUNTY JUVENILE DEPARTMENT
Entity type:Organization
Organization Name:KITSAP COUNTY JUVENILE DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-337-5401
Mailing Address - Street 1:1338 SW OLD CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9113
Mailing Address - Country:US
Mailing Address - Phone:360-337-5401
Mailing Address - Fax:360-337-5404
Practice Address - Street 1:1338 SW OLD CLIFTON RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9113
Practice Address - Country:US
Practice Address - Phone:360-337-5401
Practice Address - Fax:360-337-5404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITSAP COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA180067003245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children