Provider Demographics
NPI:1497466494
Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Entity Type:Organization
Organization Name:LEWIS COUNTY HOSPITAL DISTRICT NO. 1
Other - Org Name:ARBOR HEALTH PACKWOOD CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-496-3647
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0019
Mailing Address - Country:US
Mailing Address - Phone:360-496-5112
Mailing Address - Fax:
Practice Address - Street 1:13051 US HWY 12, STE 2
Practice Address - Street 2:
Practice Address - City:PACKWOOD
Practice Address - State:WA
Practice Address - Zip Code:98361-9835
Practice Address - Country:US
Practice Address - Phone:360-496-5112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty