Provider Demographics
NPI:1235759879
Name:PENINSULA COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:PENINSULA COMMUNITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JA-ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-377-3776
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-0212
Mailing Address - Country:US
Mailing Address - Phone:360-377-3776
Mailing Address - Fax:360-373-2096
Practice Address - Street 1:4841 AUTO CENTER WAY STE 203
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4388
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty