Provider Demographics
NPI:1770659807
Name:LEWIS COUNTY
Entity type:Organization
Organization Name:LEWIS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-740-1223
Mailing Address - Street 1:360 NW NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-1925
Mailing Address - Country:US
Mailing Address - Phone:360-740-1223
Mailing Address - Fax:360-740-1145
Practice Address - Street 1:360 NW NORTH ST
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-1925
Practice Address - Country:US
Practice Address - Phone:360-740-1223
Practice Address - Fax:360-740-1145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-28
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7058167Medicaid
WA7405640Medicaid
WA7900095Medicaid
WA8063242Medicaid
WA7405632Medicaid
WAG8877260Medicare PIN