Provider Demographics
NPI:1184797433
Name:KENNEWICK PUBLIC HOSPITAL DISTRICT
Entity type:Organization
Organization Name:KENNEWICK PUBLIC HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULFS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:509-582-2273
Mailing Address - Street 1:18 N AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3807
Mailing Address - Country:US
Mailing Address - Phone:509-582-2273
Mailing Address - Fax:509-586-5102
Practice Address - Street 1:18 N AUBURN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3807
Practice Address - Country:US
Practice Address - Phone:509-582-2273
Practice Address - Fax:509-586-5102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEWICK PUBLIC HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-16
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTS-2700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9003146Medicaid
WA0087974OtherLABOR AND INDUSTRIES
WA611184000OtherDOL OWCP
WA9006321OtherDME
WA0087974OtherLABOR AND INDUSTRIES