Provider Demographics
NPI:1275678088
Name:ASOTIN COUNTY HEALTH DISTRICT
Entity Type:Organization
Organization Name:ASOTIN COUNTY HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:509-758-3344
Mailing Address - Street 1:431 ELM ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2650
Mailing Address - Country:US
Mailing Address - Phone:509-758-3344
Mailing Address - Fax:509-758-8454
Practice Address - Street 1:431 ELM ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2650
Practice Address - Country:US
Practice Address - Phone:509-758-3344
Practice Address - Fax:509-758-8454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601-642-674251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7400906Medicaid
WA7038375Medicaid
WA8013922Medicaid
WA7038375Medicaid
WA8013922Medicaid