Provider Demographics
NPI:1386774222
Name:GARFIELD COUNTY HEALTH DISTRICT
Entity type:Organization
Organization Name:GARFIELD COUNTY HEALTH DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-843-3412
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:POMEROY
Mailing Address - State:WA
Mailing Address - Zip Code:99347-0130
Mailing Address - Country:US
Mailing Address - Phone:509-843-3412
Mailing Address - Fax:
Practice Address - Street 1:121 SOUTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:POMEROY
Practice Address - State:WA
Practice Address - Zip Code:99347
Practice Address - Country:US
Practice Address - Phone:509-843-3412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025084251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7405806Medicaid
WA5044011Medicaid
WA7034739Medicaid
WA5044011Medicaid
WA7405806Medicaid