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General NPI Number Information
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NPI Number | 1780320465
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Entity Type | Organization
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Legal Business Name | PENINSULA COMMUNITY HEALTH SERVICES
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Dates
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Enumeration Date | 05/06/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 832 6TH ST RM STD BY ME
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City | BREMERTON
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State | WA
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Zip | 98337-1441
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Country | US
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Telephone | 360-377-3776
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 960
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City | BREMERTON
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State | WA
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Zip | 98337-0212
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Country | US
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Telephone | 360-377-3776
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOEL EMERY
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Credential |
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Telephone | 360-475-6710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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