Healthcare Provider Details

I. General information

NPI: 1912203068
Provider Name (Legal Business Name): OKANOGAN DOUGLAS COUNTY HOSPITAL DISTRICT #1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 HOSPITAL WAY
BREWSTER WA
98812-0577
US

IV. Provider business mailing address

PO BOX 577 507 HOSPITAL WAY
BREWSTER WA
98812-0577
US

V. Phone/Fax

Practice location:
  • Phone: 509-689-2517
  • Fax: 509-689-2086
Mailing address:
  • Phone: 509-689-2517
  • Fax: 509-689-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH023
License Number StateWA

VIII. Authorized Official

Name: MRS. WANDA SUE CELEONE
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 509-645-3360