Healthcare Provider Details

I. General information

NPI: 1245566231
Provider Name (Legal Business Name): CHURCH IN ACTION/SAFEHOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 SW LOOKING GLASS LOOP
OAK HARBOR WA
98277-4564
US

IV. Provider business mailing address

PO BOX 193
OAK HARBOR WA
98277-0193
US

V. Phone/Fax

Practice location:
  • Phone: 360-544-8477
  • Fax:
Mailing address:
  • Phone: 360-544-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PROF. RHETTMAN ALEXANDER MULLIS JR.
Title or Position: PRESIDENT - THERAPIST
Credential: MS, RC
Phone: 360-544-8477