Provider Demographics
NPI:1093825200
Name:LINCOLN COUNTY HOSPITAL DISTRICT #3
Entity Type:Organization
Organization Name:LINCOLN COUNTY HOSPITAL DISTRICT #3
Other - Org Name:VISTA MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:D
Authorized Official - Last Name:LINSTRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-725-7101
Mailing Address - Street 1:10 NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9729
Mailing Address - Country:US
Mailing Address - Phone:509-725-7101
Mailing Address - Fax:509-725-2112
Practice Address - Street 1:700 SE BRACE ST
Practice Address - Street 2:
Practice Address - City:WILBUR
Practice Address - State:WA
Practice Address - Zip Code:99185-8801
Practice Address - Country:US
Practice Address - Phone:509-647-2211
Practice Address - Fax:509-647-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABH1103310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA645833Medicaid