Provider Demographics
NPI:1730278755
Name:CHELAN-DOUGLAS HEALTH DISTRICT
Entity Type:Organization
Organization Name:CHELAN-DOUGLAS HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-886-6480
Mailing Address - Street 1:200 VALLEY MALL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802
Mailing Address - Country:US
Mailing Address - Phone:509-886-6400
Mailing Address - Fax:509-886-6478
Practice Address - Street 1:200 VALLEY MALL PARKWAY
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802
Practice Address - Country:US
Practice Address - Phone:509-886-6400
Practice Address - Fax:509-886-6478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60005350554251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7311004Medicaid
WA7401185Medicaid
WA7403538Medicaid
WA7311004Medicaid
WA7401185Medicaid