Provider Demographics
NPI:1326139528
Name:CLALLAM COUNTY JUVENILE AND FAMILY SERVICES
Entity Type:Organization
Organization Name:CLALLAM COUNTY JUVENILE AND FAMILY SERVICES
Other - Org Name:TRUE STAR RECOVERY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-565-2628
Mailing Address - Street 1:1912 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-5121
Mailing Address - Country:US
Mailing Address - Phone:360-565-2621
Mailing Address - Fax:360-457-4875
Practice Address - Street 1:1912 W 18TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98363-5121
Practice Address - Country:US
Practice Address - Phone:360-565-2621
Practice Address - Fax:360-457-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91136OtherPSE HEALTHTRUST
WA8022592Medicaid