Provider Demographics
NPI:1366506420
Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 3
Entity Type:Organization
Organization Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 3
Other - Org Name:COLUMBIA BASIN HOSPITAL SWING BED
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-754-4631
Mailing Address - Street 1:200 NAT WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1973
Mailing Address - Country:US
Mailing Address - Phone:509-754-4631
Mailing Address - Fax:509-754-6356
Practice Address - Street 1:200 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1973
Practice Address - Country:US
Practice Address - Phone:509-754-4631
Practice Address - Fax:509-754-6356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50Z317Medicare Oscar/Certification