Healthcare Provider Details

I. General information

NPI: 1790869592
Provider Name (Legal Business Name): CLALLAM COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BOGACHIEL WAY
FORKS WA
98331-9120
US

IV. Provider business mailing address

530 BOGACHIEL WAY
FORKS WA
98331
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-5011
  • Fax:
Mailing address:
  • Phone: 360-374-6271
  • Fax: 360-374-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number069
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWA

VIII. Authorized Official

Name: TIM COUMYER
Title or Position: CEO
Credential:
Phone: 360-374-6271