Healthcare Provider Details

I. General information

NPI: 1609410075
Provider Name (Legal Business Name): GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WILLIAM AVE
MATTAWA WA
99349-0104
US

IV. Provider business mailing address

210 GOVERNMENT RD
MATTAWA WA
99349-5116
US

V. Phone/Fax

Practice location:
  • Phone: 509-932-4499
  • Fax: 509-932-5363
Mailing address:
  • Phone: 509-932-4499
  • Fax: 509-932-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DANA S FOX
Title or Position: CEO
Credential:
Phone: 509-932-4499