HOLLY RIDGE CENTER (NPI# 1861549206) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861549206 |
| Entity Type | Organization |
| Organization Name | HOLLY RIDGE CENTER |
| Practice Address |
5112 Nw Taylor Rd Bremerton WA 98312-8837 |
| Practice Telephone | 3603732536 |
| Practice Fax Number | 3603734934 |
| Mailing Telephone | 3603732536 |
| Mailing Fax Number | 3603734934 |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MS. ROXANNE BRYSON (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 3603732536 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| X | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| X | 2080P0006X |
Pediatrics Specialization: Developmental – Behavioral Pediatrics |
Allopathic & Osteopathic Physicians | ||
| X | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| X | 364S00000X | Clinical Nurse Specialist | Physician Assistants & Advanced Practice Nursing Providers | ||
| X | 2251P0200X |
Physical Therapist Specialization: Pediatrics |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| X | 225XP0200X |
Occupational Therapist Specialization: Pediatrics |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 7007271 | 05 | |
| WA | 7017742 | 05 | |
| WA | 7660228 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | HOLLY RIDGE CENTER | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 |
| Street Address |
5112 NW TAYLOR RD |
| City | BREMERTON |
| State | WA |
| Zip Code | 98312-8837 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942358239 | Kathrin Bires Fortner | Physical Therapist | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2007-01-05 |
| 1750905261 | Stacy Alynn Scott | Social Worker | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2020-05-31 |
| 1841811056 | Madison Prentiss | Behavior Technician | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2020-04-28 |
| 1588201909 | Spencer Bailey | Behavior Technician | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2019-12-04 |
| 1134766702 | Sarah Christine Matter | Behavior Technician | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2019-12-03 |
| 1508408048 | Laura Qualls | Speech-Language Pathologist | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2019-10-16 |
| 1902462666 | Sarah Diller | Occupational Therapist | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2019-05-17 |
| 1568955581 | Molly Perri | Speech-Language Pathologist | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2018-06-13 |
| 1649762261 | Jessica Enyeart | Occupational Therapist | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2018-05-30 |
| 1417445495 | Kera Elizabeth Hayden | Behavior Technician | 5112 Nw Taylor Rd, Bremerton, WA 98312-8837 | 2018-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962025114 | Candace Mckenzie | Counselor | 2564 Cascades Pass Blvd, The Landings Bldg. 779, Bremerton, WA 98312 | 2020-05-22 |
| 1710473590 | Sandra Louise Walker | Family Medicine | 14301 Nw Coho Run, Bremerton, WA 98312 | 2018-07-05 |
| 1467947663 | Jason David Alexander | Military Health Care Provider | Uss Kentucky, Ssbn, Fpo, AE 98312 | 2018-06-29 |
| 1588176614 | Institute Family for Development | Community/Behavioral Health | 5610 Kitsap Way, Suite 315, Bremerton, WA 98312 | 2017-10-30 |
| 1720521321 | Debra Lynn Lemieux | Counselor | 5762 Chico Way Nw, Bremerton, WA 98312 | 2016-11-30 |
| 1164840047 | Amber Rose Morison | Chiropractor | 3963 Sand Dollar Road West, Bremerton, WA 98312 | 2014-03-28 |
| 1942625611 | Kristen Williams | Clinic/Center | 5112 Nw Taylor Rd., Bremerton, WA 98312 | 2014-03-04 |
| 1184049629 | Tariku Tsegaye Messele | Specialist/Technologist | 5112 Nw Taylor Road, Bremerton, WA 98312 | 2014-02-20 |
| 1063784064 | Johnson Chiropractic Clinic | Clinic/Center | 3721 Kitsap Way Suite #8, Bremerton, WA 98312 | 2012-02-06 |
| 1194013532 | Casey Mccann | Student in an Organized Health Care Education/Training Program | 1 Boone Rd., Naval Hospital Bremerton, Bremerton, WA 98312 | 2011-07-19 |
| Find all providers in zip 98312 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
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| 1700396652 | Multicare Health System | Psychologist | 1706 S Meridian Ste 120, Puyallup, WA 98371-7516 | 2017-10-05 |
| 1427417880 | Lord Psychological Services, LLC | Psychologist | 826 102nd Ave Ne, #400, Bellevue, WA 98004-4162 | 2016-02-14 |
| 1689060964 | Anne Bernard Arnett | Psychologist | Chdd Uw, Seattle, WA 98195-0001 | 2015-04-13 |
| 1982033940 | Elizabeth J. Wasson | Psychologist | 4033 E Madison St Ste 203, Seattle, WA 98112-3104 | 2013-11-10 |
| 1851655971 | Sarah Peregrine Lord | Psychologist | 826 102nd Ave Ne Ste 400, Bellevue, WA 98004-4158 | 2012-07-03 |
| 1053695023 | Kristina C. Kwon | Psychologist | 365 118th Ave Se Ste 118, Bellevue, WA 98005-3557 | 2011-10-07 |
| 1992099618 | Chitra Iyer | Psychologist | 15027 Bel Red Rd, Bellevue, WA 98007-4211 | 2011-05-31 |
| 1669700662 | Sol Case Management | Psychologist | 117 S. 3rd Ave., Pasco, WA 99301 | 2009-12-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.