Provider Demographics
NPI:1962406389
Name:CHELAN COUNTY PUBLIC HOSPITAL DISTRICT NO. 1
Entity type:Organization
Organization Name:CHELAN COUNTY PUBLIC HOSPITAL DISTRICT NO. 1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-548-3425
Mailing Address - Street 1:817 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1316
Mailing Address - Country:US
Mailing Address - Phone:509-548-5815
Mailing Address - Fax:509-548-2510
Practice Address - Street 1:817 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1316
Practice Address - Country:US
Practice Address - Phone:509-548-5815
Practice Address - Fax:509-548-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X, 282NC0060X, 282NR1301X
WAH-158282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
No282N00000XHospitalsGeneral Acute Care Hospital
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7027311Medicaid
WA0013042OtherDEPARTMENT OF LABOR & INDUSTRIES
WA0025919OtherDEPARTMENT OF LABOR & INDUSTRIES