Provider Demographics
NPI:1639118490
Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Entity Type:Organization
Organization Name:PROSSER PUBLIC HOSPITAL DISTRICT OF BENTON COUNTY
Other - Org Name:PROSSER MEMORIAL HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-786-2222
Mailing Address - Street 1:723 MEMORIAL STREET
Mailing Address - Street 2:
Mailing Address - City:PROSSER
Mailing Address - State:WA
Mailing Address - Zip Code:99350-1524
Mailing Address - Country:US
Mailing Address - Phone:509-786-2222
Mailing Address - Fax:509-786-6612
Practice Address - Street 1:723 MEMORIAL STREET
Practice Address - Street 2:
Practice Address - City:PROSSER
Practice Address - State:WA
Practice Address - Zip Code:99350-1524
Practice Address - Country:US
Practice Address - Phone:509-786-2222
Practice Address - Fax:509-786-6612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSSER PUBLIC HOSPTIAL DISTRICT OF BENTON CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS414251E00000X
WAIHSFS.00000414251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA100887OtherL & I HOME HEALTH
WA100888OtherL & I HOME IV
WA9040254Medicaid
WA507103Medicare Oscar/Certification
WA9040254Medicaid