Provider Demographics
NPI:1295227726
Name:KITSAP COUNTY AGING
Entity Type:Organization
Organization Name:KITSAP COUNTY AGING
Other - Org Name:KITSAP COUNTY DIVISION OF AGING AND LONG TERM CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ANN SPENCER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LMHC, CMHS
Authorized Official - Phone:360-337-5624
Mailing Address - Street 1:614 DIVISION ST # MS -23
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4614
Mailing Address - Country:US
Mailing Address - Phone:360-337-5700
Mailing Address - Fax:360-337-5746
Practice Address - Street 1:1026 SIDNEY AVE STE 105
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4298
Practice Address - Country:US
Practice Address - Phone:360-337-5700
Practice Address - Fax:360-337-5746
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITSAP COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management