Provider Demographics
NPI:1427802917
Name:KINGS COUNTY JUVENILE CENTER
Entity type:Organization
Organization Name:KINGS COUNTY JUVENILE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-852-4328
Mailing Address - Street 1:1450 FORUM DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5900
Mailing Address - Country:US
Mailing Address - Phone:559-852-4328
Mailing Address - Fax:
Practice Address - Street 1:1450 FORUM DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5900
Practice Address - Country:US
Practice Address - Phone:559-852-4328
Practice Address - Fax:559-583-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health