Healthcare Provider Details

I. General information

NPI: 1215244520
Provider Name (Legal Business Name): ASOTIN COUNTY HEALTH DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 ELM ST
CLARKSTON WA
99403-2650
US

IV. Provider business mailing address

431 ELM ST
CLARKSTON WA
99403-2650
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-3344
  • Fax:
Mailing address:
  • Phone: 509-758-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number601642674
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number601642674
License Number StateWA

VIII. Authorized Official

Name: MRS. NANCY K MAECHTLE
Title or Position: FISCAL ADMINISTRATOR
Credential:
Phone: 509-758-3344