Healthcare Provider Details

I. General information

NPI: 1558935940
Provider Name (Legal Business Name): PENINSULA COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 137TH AVE NW UNIT A
GIG HARBOR WA
98329-6617
US

IV. Provider business mailing address

PO BOX 960
BREMERTON WA
98337-0212
US

V. Phone/Fax

Practice location:
  • Phone: 360-377-3776
  • Fax: 360-373-2096
Mailing address:
  • Phone: 360-377-3776
  • Fax: 360-373-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER KREIDLER-MOSS
Title or Position: CEO
Credential:
Phone: 360-377-3776