Provider Demographics
NPI:1225033814
Name:SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Other - Org Name:ASTRIA SUNNYSIDE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-837-1655
Mailing Address - Street 1:P.O. BOX 719
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944
Mailing Address - Country:US
Mailing Address - Phone:509-837-1500
Mailing Address - Fax:509-837-1533
Practice Address - Street 1:1016 TACOMA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944
Practice Address - Country:US
Practice Address - Phone:509-837-1500
Practice Address - Fax:509-837-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X
WA275N00000X
WA600 581 630282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA147OtherPREMERA BLUE CROSS
WA10250OtherLABOR & INDUSTRIES
WA3300076Medicaid
WASU9354OtherREGENCE BLUE SHIELD
WA3300076Medicaid
50Z330Medicare Oscar/Certification
WAG000198800Medicare PIN
WA147OtherPREMERA BLUE CROSS