Healthcare Provider Details

I. General information

NPI: 1982123394
Provider Name (Legal Business Name): SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 11TH AVE STE 321
YAKIMA WA
98902-3273
US

IV. Provider business mailing address

PO BOX 22004
BELFAST ME
04915-4117
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-5071
  • Fax: 509-454-6398
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATHEW MATHIESEN
Title or Position: CFO
Credential:
Phone: 509-837-1356