Provider Demographics
NPI:1265976419
Name:KITSAP SEXUAL ASSAULT CENTER
Entity type:Organization
Organization Name:KITSAP SEXUAL ASSAULT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LARAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-479-1788
Mailing Address - Street 1:600 KITSAP ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-5341
Mailing Address - Country:US
Mailing Address - Phone:360-479-1788
Mailing Address - Fax:360-895-8696
Practice Address - Street 1:600 KITSAP ST STE 103
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5341
Practice Address - Country:US
Practice Address - Phone:360-479-1788
Practice Address - Fax:360-895-8696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health