Healthcare Provider Details

I. General information

NPI: 1639197882
Provider Name (Legal Business Name): KITTITAS COUNTY PUBLIC HOSPITAL DIST 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW AVE
ELLENSBURG WA
98926-3768
US

IV. Provider business mailing address

P.O. BOX 799
ELLENSBURG WA
98926
US

V. Phone/Fax

Practice location:
  • Phone: 509-962-7438
  • Fax: 509-925-8450
Mailing address:
  • Phone: 509-962-7438
  • Fax: 509-925-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberIS-320
License Number StateWA

VIII. Authorized Official

Name: MRS. AGGIE SPRAGUE
Title or Position: MANAGER TRANSITIONAL CARE HOME HEAL
Credential:
Phone: 509-962-7438