Individual provider Active NPI

Juline K Dual, CG60709757

  • Mental Illness Community Based Residential Treatment Facility
  • Vancouver, WA
National Provider Identifier
1740723220
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
CG60709757 Issued in WA
Practice address
7415 NE 94TH Ave
Vancouver, WA 98662-3859
Phone
(360) 253-6019
NPI assigned
Dec 1, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X CG60709757 WA Primary

Addresses

Primary practice location

7415 NE 94TH Ave
Vancouver, WA 98662-3859

Mailing address

3812 E 14TH St
Vancouver, WA 98661-5427
Phone (360) 977-9610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CG60709757WAMDMental Illness Community Based Residential Treatment Facility

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1740723220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3812 E 14TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986615427",
            "telephone_number": "360-977-9610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7415 NE 94TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986623859",
            "telephone_number": "360-253-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUAL",
        "first_name": "JULINE",
        "middle_name": "K",
        "credential": "CG60709757",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-01",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "WA",
            "license": "CG60709757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.