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General NPI Number Information
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NPI Number | 1225033814
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE COMMUNITY HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1016 TACOMA AVE
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City | SUNNYSIDE
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State | WA
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Zip | 98944
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Country | US
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Telephone | 509-837-1500
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Fax | 509-837-1533
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Provider Business Mailing Address
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Address Line | P.O. BOX 719
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City | SUNNYSIDE
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State | WA
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Zip | 98944
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Country | US
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Telephone | 509-837-1500
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Fax | 509-837-1533
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Authorized Official
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Title or Position | CFO
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Name | MR. MATHEW MATHIESEN
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Credential |
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Telephone | 509-837-1655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number |
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 600 581 630
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License Number State | WA
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