Provider Demographics
NPI:1740205988
Name:PUBLIC HOSPITAL DISTRICT #4 OF GRANT COUNTY
Entity Type:Organization
Organization Name:PUBLIC HOSPITAL DISTRICT #4 OF GRANT COUNTY
Other - Org Name:MCKAY HEALTHCARE & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:COWLISHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-246-1111
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:SOAP LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98851-0819
Mailing Address - Country:US
Mailing Address - Phone:509-246-1111
Mailing Address - Fax:509-246-0371
Practice Address - Street 1:127 2ND AVE. SW
Practice Address - Street 2:
Practice Address - City:SOAP LAKE
Practice Address - State:WA
Practice Address - Zip Code:98851
Practice Address - Country:US
Practice Address - Phone:509-246-1111
Practice Address - Fax:509-246-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA867314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA505390Medicare Oscar/Certification