Provider Demographics
NPI:1801003439
Name:KITSAP COUNTY
Entity Type:Organization
Organization Name:KITSAP COUNTY
Other - Org Name:KITSAP RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROMWALL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:360-337-4625
Mailing Address - Street 1:1975 NE FUSON RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-3738
Mailing Address - Country:US
Mailing Address - Phone:360-337-4625
Mailing Address - Fax:
Practice Address - Street 1:1975 NE FUSON RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3738
Practice Address - Country:US
Practice Address - Phone:360-337-4625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA18006700324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1991090Medicaid