Provider Demographics
NPI:1508081217
Name:COUNTY OF PACIFIC
Entity Type:Organization
Organization Name:COUNTY OF PACIFIC
Other - Org Name:PACIFIC COUNTY PUBLIC HEALTH AND HUMAN SERVICE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:O
Authorized Official - Last Name:LINDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-589-9061
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0026
Mailing Address - Country:US
Mailing Address - Phone:360-875-9343
Mailing Address - Fax:360-875-9323
Practice Address - Street 1:1216 WEST ROBERT BUSH DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586
Practice Address - Country:US
Practice Address - Phone:360-875-9343
Practice Address - Fax:360-875-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7403801Medicaid
WA7902703Medicaid
WA7400930Medicaid
WA7261308Medicaid