Healthcare Provider Details

I. General information

NPI: 1508081217
Provider Name (Legal Business Name): COUNTY OF PACIFIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 WEST ROBERT BUSH DRIVE
SOUTH BEND WA
98586
US

IV. Provider business mailing address

PO BOX 26
SOUTH BEND WA
98586-0026
US

V. Phone/Fax

Practice location:
  • Phone: 360-875-9343
  • Fax: 360-875-9323
Mailing address:
  • Phone: 360-875-9343
  • Fax: 360-875-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: GRACIE E MINKS
Title or Position: DEPUTY DIRECTOR
Credential:
Phone: 360-214-6087