1083084677 NPI number — GRAYS HARBOR COMMUNITY HOSPITAL

Table of content: (NPI 1083084677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083084677 NPI number — GRAYS HARBOR COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAYS HARBOR COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GHCH ABERDEEN F STREET CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083084677
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 ANDERSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98520-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 E PIONEER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTESANO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98563-4601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-249-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FOLEY
Authorized Official First Name:
NIALL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
360-537-5145

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100366800 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com