Provider Demographics
NPI:1023677523
Name:SKOOKUM EDUCATIONAL PROGRAMS
Entity type:Organization
Organization Name:SKOOKUM EDUCATIONAL PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-475-0756
Mailing Address - Street 1:PO BOX 5359
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-0518
Mailing Address - Country:US
Mailing Address - Phone:360-475-0756
Mailing Address - Fax:
Practice Address - Street 1:4525 AUTO CENTER WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-4312
Practice Address - Country:US
Practice Address - Phone:360-475-0756
Practice Address - Fax:360-475-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management