Provider Demographics
NPI:1033259601
Name:HARRISON MEDICAL CENTER
Entity Type:Organization
Organization Name:HARRISON MEDICAL CENTER
Other - Org Name:HARRISON HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-744-6505
Mailing Address - Street 1:2520 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4229
Mailing Address - Country:US
Mailing Address - Phone:360-744-3911
Mailing Address - Fax:
Practice Address - Street 1:4205 WHEATON WAY
Practice Address - Street 2:SUITE A
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3626
Practice Address - Country:US
Practice Address - Phone:360-744-6750
Practice Address - Fax:360-744-6772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARRISON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000895Medicaid
WA1000895Medicaid
507076Medicare PIN