Provider Demographics
NPI:1225475858
Name:BREMERTON HOUSING AUTHORITY
Entity Type:Organization
Organization Name:BREMERTON HOUSING AUTHORITY
Other - Org Name:BAY VISTA COMMONS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-616-7241
Mailing Address - Street 1:PO BOX 2189
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-0294
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:191 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3415
Practice Address - Country:US
Practice Address - Phone:360-377-8300
Practice Address - Fax:360-377-6090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1983310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1983OtherBOARDING HOME LICENSE