Organization · Type 2 NPI

Department of Social Dept of SHS Div of Instns

Psychiatric Hospital · Medical Lake, WA

NPI number 1467440602 Active

Practice location

850 Maple St
Medical Lake, WA 99022-0800

Call (509) 565-4000 Map

Fax (509) 565-4705

Mailing address

PO Box 800, 850 Maple St
Medical Lake, WA 99022-0800

Specialties and licenses

Taxonomy	Code	License
Psychiatric Hospital Primary	283Q00000X	None listed

Psychiatric Hospital: An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.

NPI record

NPI: 1467440602
Entity type: Organization (Type 2)
Issued: Oct 12, 2005
Last updated: Mar 10, 2022
Status: Active

Other names

<unavail>
Eastern State Hospital · doing business as
Eastern State Hospital · doing business as

Authorized official

Jessica Helene Graham
Director, Revenue Cycle
(509) 565-4131

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

Is this your record? How to update it.

About NPI 1467440602

Department of Social Dept of SHS Div of Instns's National Provider Identifier is 1467440602, issued on Oct 12, 2005. The primary taxonomy on file is Psychiatric Hospital (283Q00000X), and the practice location is in Medical Lake, WA. The record was last updated on Mar 10, 2022.