- Enrollment id
- O20090223000482
- Enrollment state
- WA
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1851477061
- Multiple npi flag
- N
- Ccn
- 501539
- Associate id
- 0648164269
- Organization name
- KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1
- Doing business as name
- KLICKITAT VALLEY HEALTH
- Incorporation date
- 1941-01-01
- Incorporation state
- WA
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 310 S ROOSEVELT ST
- City
- GOLDENDALE
- State
- WA
- Zip code
- 986209201