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Organization

DEPARTMENT OF SOCIAL DEPT OF SHS DIV OF INSTNS

Active
Other names
Eastern State Hospital
Organization subpart
No

Provider details

NPI number
Authorized official
JESSICA HELENE GRAHAM (DIRECTOR, REVENUE CYCLE)
(509) 565-4131
Entity
Organization

Contact information

Practice address
850 MAPLE ST, MEDICAL LAKE, WA 99022-0800
(509) 565-4000
(509) 565-4705
Mailing address
PO BOX 800, 850 MAPLE ST, MEDICAL LAKE, WA 99022-0800
(509) 565-4000
(509) 565-4705

Taxonomy

Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary

Other

Enumeration date
10/12/2005
Last updated
03/10/2022
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