Organization
JEFFERSON HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE GLENN (CEO)
(360) 385-2200
Entity
Organization
Contact information
Practice address
834 SHERIDAN ST, DEPARTMENT OF PHARMACY, PORT TOWNSEND, WA 98368-2443
(360) 385-2200
(360) 385-6925
Mailing address
834 SHERIDAN ST, DEPARTMENT OF PHARMACY, PORT TOWNSEND, WA 98368-2443
(360) 385-2200
(360) 385-6925
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
PH 60291084
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH 60291084
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
01/19/2015
Last updated
01/19/2015
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