1790034627 NPI number — CLARK COUNTY JUVENILE COURT

Table of content: (NPI 1790034627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790034627 NPI number — CLARK COUNTY JUVENILE COURT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARK COUNTY JUVENILE COURT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790034627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98666-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-397-2201
Provider Business Mailing Address Fax Number:
360-397-2246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W 11TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-397-2201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ESCAMILLA
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
JUVENILE COURT ADMINISTRATOR
Authorized Official Telephone Number:
360-397-2201

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LF00001940 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)