Healthcare Provider Details

I. General information

NPI: 1326139528
Provider Name (Legal Business Name): CLALLAM COUNTY JUVENILE AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 W 18TH ST
PORT ANGELES WA
98363-5121
US

IV. Provider business mailing address

1912 W 18TH ST
PORT ANGELES WA
98363-5121
US

V. Phone/Fax

Practice location:
  • Phone: 360-565-2621
  • Fax: 360-457-4875
Mailing address:
  • Phone: 360-565-2621
  • Fax: 360-457-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETE PETERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 360-565-2628