=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699808832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WASHINGTON COUNTY JUVENILE SHELTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 11/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 244 W MAIN STREET
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97123
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-846-8766
-----------------------------------------------------
Fax | 503-846-3556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 N. FIRST AVENUE
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97124-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-846-8861
-----------------------------------------------------
Fax | 503-846-8886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF JUVENILE DEPARTMENT
-----------------------------------------------------
Name | DR. JOSEPH T CHRISTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-846-8861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------