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General NPI Number Information
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NPI Number | 1609410075
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Entity Type | Organization
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Legal Business Name | GRANT COUNTY PUBLIC HOSPITAL DISTRICT NO 5
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 101 S WILLIAM AVE
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City | MATTAWA
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State | WA
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Zip | 99349-0104
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Country | US
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Telephone | 509-932-4499
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Fax | 509-932-5363
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Provider Business Mailing Address
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Address Line | 210 GOVERNMENT RD
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City | MATTAWA
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State | WA
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Zip | 99349-5116
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Country | US
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Telephone | 509-932-4499
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Fax | 509-932-5363
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Authorized Official
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Title or Position | CEO
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Name | DANA S FOX
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Credential |
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Telephone | 509-932-4499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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