Provider Demographics
NPI:1295915247
Name:GRANT COUNTY HEALTH DISTRICT
Entity type:Organization
Organization Name:GRANT COUNTY HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-766-7960
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-0037
Mailing Address - Country:US
Mailing Address - Phone:509-754-6060
Mailing Address - Fax:509-766-6595
Practice Address - Street 1:1038 W IVY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2049
Practice Address - Country:US
Practice Address - Phone:509-766-7960
Practice Address - Fax:509-766-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8011538Medicaid
WA7318504Medicaid
WA7404817Medicaid