Healthcare Provider Details

I. General information

NPI: 1659132215
Provider Name (Legal Business Name): KITSAP COUNTY DRUG COURT ALUMNI ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5691 KITSAP WAY
BREMERTON WA
98312-2222
US

IV. Provider business mailing address

PO BOX 2981
BREMERTON WA
98310-0382
US

V. Phone/Fax

Practice location:
  • Phone: 360-616-2018
  • Fax:
Mailing address:
  • Phone: 360-912-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNGELA M OLSON
Title or Position: PRESIDENT
Credential:
Phone: 360-912-2508