Provider Demographics
NPI:1609410075
Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5
Entity Type:Organization
Organization Name:GRANT COUNTY PUBLIC HOSPITAL DISTRICT 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-932-4499
Mailing Address - Street 1:PO BOX 1581
Mailing Address - Street 2:
Mailing Address - City:MATTAWA
Mailing Address - State:WA
Mailing Address - Zip Code:99349-0960
Mailing Address - Country:US
Mailing Address - Phone:095-932-4499
Mailing Address - Fax:509-932-5363
Practice Address - Street 1:101 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:MATTAWA
Practice Address - State:WA
Practice Address - Zip Code:99349-0104
Practice Address - Country:US
Practice Address - Phone:509-932-4499
Practice Address - Fax:509-932-5363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO. 5
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1699720797Medicaid