Provider Demographics
NPI:1376546515
Name:HOSPICE OF KITSAP COUNTY
Entity Type:Organization
Organization Name:HOSPICE OF KITSAP COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOSPICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-698-4611
Mailing Address - Street 1:PO BOX 3416
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3416
Mailing Address - Country:US
Mailing Address - Phone:360-698-4611
Mailing Address - Fax:360-692-1893
Practice Address - Street 1:3100 NW BUCKLIN HILL RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8358
Practice Address - Country:US
Practice Address - Phone:360-698-4611
Practice Address - Fax:360-692-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-335251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3990066Medicaid
WA3990066Medicaid