Provider Demographics
NPI:1831805134
Name:PROACTIVE SUPPORTIVE HOUSING SERVICES, INC.
Entity type:Organization
Organization Name:PROACTIVE SUPPORTIVE HOUSING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-952-3997
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-0936
Mailing Address - Country:US
Mailing Address - Phone:360-952-3997
Mailing Address - Fax:
Practice Address - Street 1:218 N 3RD ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3502
Practice Address - Country:US
Practice Address - Phone:360-952-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROACTIVE SUPPORTIVE HOUSING SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management