Provider Demographics
NPI:1376561654
Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity Type:Organization
Organization Name:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER TRANSITIONAL CARE HOME HEAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-7438
Mailing Address - Street 1:P.O. BOX 799
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-962-7438
Mailing Address - Fax:509-925-8450
Practice Address - Street 1:309 E MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3768
Practice Address - Country:US
Practice Address - Phone:509-925-8499
Practice Address - Fax:509-925-8450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-17
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-320251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA009490004OtherGROUP HEALTH COOPERATIVE
WA44265OtherST OF WA LABOT & INDUSTRI
WA9036823Medicaid
WA152OtherBLUE CROSS OF WASHINGTON
WA152OtherBLUE CROSS OF WASHINGTON
WA=========OtherUNIFORM MEDICAL PLAN