1295227726 NPI number — KITSAP COUNTY AGING

Table of content: (NPI 1295227726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295227726 NPI number — KITSAP COUNTY AGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KITSAP COUNTY AGING
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:
KITSAP COUNTY DIVISION OF AGING AND LONG TERM CARE
Provider Other Organization Name Type Code:
4
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:
1295227726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 DIVISION ST # MS -23
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-4614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-337-5700
Provider Business Mailing Address Fax Number:
360-337-5746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 SIDNEY AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-4298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-337-5700
Provider Business Practice Location Address Fax Number:
360-337-5746
Provider Enumeration Date:
05/31/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
ANN SPENCER
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
360-337-5624

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com