Provider Demographics
NPI:1437374816
Name:JUMPING MOUSE CHILDREN'S CENTER
Entity Type:Organization
Organization Name:JUMPING MOUSE CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DATA AND FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-379-5109
Mailing Address - Street 1:1809 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-7610
Mailing Address - Country:US
Mailing Address - Phone:360-379-5109
Mailing Address - Fax:360-385-2684
Practice Address - Street 1:1809 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-7610
Practice Address - Country:US
Practice Address - Phone:360-379-5109
Practice Address - Fax:360-385-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601174144251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health