Basic Information
| Provider Information | |||||||||
| NPI: | 1578163317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KLAHOWYA SCHOOL BASE HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 WARREN AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | BREMERTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983371467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604756711 | ||||||||
| FaxNumber: | 3603732096 | ||||||||
| Practice Location | |||||||||
| Address1: | 7607 NW NEWBERRY HILL RD RM CLINIC | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983837313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603773776 | ||||||||
| FaxNumber: | 3603732096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2020 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | GI8BSON | ||||||||
| AuthorizedOfficialFirstName: | ALISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3604756711 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PENINSULA COMMUNITY HEALTH SERVICES | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QA0005X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QD0000X | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 261QF0050X | N | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 3245S0500X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.