Healthcare Provider Details

I. General information

NPI: 1114031614
Provider Name (Legal Business Name): LINCOLN COUNTY PUBLIC HOSPITAL DISTRICT 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 E. AMENDE
ODESSA WA
99159
US

IV. Provider business mailing address

PO BOX 188
ODESSA WA
99159-0188
US

V. Phone/Fax

Practice location:
  • Phone: 509-982-2611
  • Fax: 509-982-2159
Mailing address:
  • Phone: 509-982-2611
  • Fax: 509-982-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberBH1194
License Number StateWA

VIII. Authorized Official

Name: JOHN SERLE
Title or Position: CEO
Credential:
Phone: 509-982-2611