Healthcare Provider Details

I. General information

NPI: 1891879680
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: 05/19/2021
Certification Date: 05/19/2021
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
98331-9120
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberH-054
License Number StateWA

VIII. Authorized Official

Name: STARLA DAMAN
Title or Position: BILLING MANGER
Credential:
Phone: 360-374-6271