1639197882 NPI number — KITTITAS COUNTY PUBLIC HOSPITAL DIST 1

Table of content: (NPI 1639197882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639197882 NPI number — KITTITAS COUNTY PUBLIC HOSPITAL DIST 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
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:
Provider Other Organization Name Type Code:
6
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:
1639197882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLENSBURG
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98926
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-962-7438
Provider Business Mailing Address Fax Number:
509-925-8450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 E MOUNTAIN VIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENSBURG
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98926-3768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-962-7438
Provider Business Practice Location Address Fax Number:
509-925-8450
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPRAGUE
Authorized Official First Name:
AGGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER TRANSITIONAL CARE HOME HEAL
Authorized Official Telephone Number:
509-962-7438

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  IS-320 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 91757683 . This is a "UNIFORM MED PLAN-HOSPICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 152 . This is a "BLUE CROSS-HOSPICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 835 . This is a "GROPU HLTH COOP-HOSPICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3990314 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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