Healthcare Provider Details

I. General information

NPI: 1962576777
Provider Name (Legal Business Name): GRANT COUNTY PUBLIC HOSPITAL DISTRICT 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 10TH AVE SW
QUINCY WA
98848-1376
US

IV. Provider business mailing address

908 10TH AVE SW
QUINCY WA
98848-1376
US

V. Phone/Fax

Practice location:
  • Phone: 509-787-3531
  • Fax: 509-787-2016
Mailing address:
  • Phone: 509-787-3531
  • Fax: 509-787-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberH129
License Number StateWA

VIII. Authorized Official

Name: MEHDI MERRED
Title or Position: CEO
Credential:
Phone: 509-787-5346