Provider Demographics
NPI:1750554366
Name:GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity type:Organization
Organization Name:GRAYS HARBOR COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-495-3244
Mailing Address - Street 1:600 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541
Mailing Address - Country:US
Mailing Address - Phone:360-495-3244
Mailing Address - Fax:360-495-4274
Practice Address - Street 1:600 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541
Practice Address - Country:US
Practice Address - Phone:360-495-3244
Practice Address - Fax:360-495-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH-186275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQMXPR0048030OtherMOLINA H/O
WA18091OtherL&I ER FACILITY
WACD1667OtherRAILROAD MEDICARE
WA135OtherPREMERA
WA7257108Medicaid
WA8903272OtherCRIME VICTIMS
WAGR6577OtherREGENCE BLUE SHEILD
WA18090OtherL&I ER DOC NUMBER
WA3147709Medicaid
WAG000800088OtherMEDICARE PRO FEE
WA135OtherPREMERA