Provider Demographics
NPI:1699808832
Name:WASHINGTON COUNTY JUVENILE SHELTER
Entity Type:Organization
Organization Name:WASHINGTON COUNTY JUVENILE SHELTER
Other - Org Name:HARKINS HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF JUVENILE DEPARTMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHRISTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-846-8861
Mailing Address - Street 1:222 N. FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-3961
Mailing Address - Country:US
Mailing Address - Phone:503-846-8861
Mailing Address - Fax:503-846-8886
Practice Address - Street 1:244 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123
Practice Address - Country:US
Practice Address - Phone:503-846-8766
Practice Address - Fax:503-846-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR215145Medicaid