Basic Information
| Provider Information | |||||||||
| NPI: | 1922410075 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHELAN COUNTY PUBLIC HOPSITAL DISTRICT NO 2 | ||||||||
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| OtherOrganizationName: | LAKE CHELAN COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 E HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHELAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988168631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096823300 | ||||||||
| FaxNumber: | 5096829614 | ||||||||
| Practice Location | |||||||||
| Address1: | 503 E HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | CHELAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988168631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096823300 | ||||||||
| FaxNumber: | 5096829614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2014 | ||||||||
| LastUpdateDate: | 05/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | ABEL | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5096823300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC0050X | 00000165 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital |
No ID Information.