NPIMap

Organization Active NPI

Lewis County Hospital District No 1

Doing business as Arbor Health Mossyrock Clinic

  • Rural Health Clinic/Center
  • Mossyrock, WA
National Provider Identifier
1205110830
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H173 Issued in WA
Legal business name
LEWIS COUNTY HOSPITAL DISTRICT NO 1
Doing business as
Arbor Health Mossyrock Clinic
Practice address
745 Williams Street
Mossyrock, WA 98564
Phone
(360) 983-8990
Fax
(360) 983-8995
NPI assigned
Sep 30, 2011
Last updated
Dec 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janice Cramer
Title
Authorized Official
Phone
(360) 496-5112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H173 WA Primary

Addresses

Primary practice location

745 Williams Street
Mossyrock, WA 98564

Mailing address

PO Box 1138
Morton, WA 98356-0019
Phone (360) 496-3702

Other names 1

  • Arbor Health Mossyrock Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000601 WA Part A Provider - Rural Health Clinic 6002727385 Practice locations: Mossyrock, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205110830. Details of each certification follow.

Rural health clinic certification: CCN 508557

Legal name
LEWIS COUNTY HOSPITAL DISTRICT NO 1
Doing business as
ARBOR HEALTH MOSSYROCK CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 10, 2007
Last certification
Jan 29, 2014
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Dec 2, 1976 in WA
Enrollment address
745 Williams St
Mossyrock, WA 98564-9004
Related CCNs
501319

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
LCHD 1 Morton Gen Hosp9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Craig Coppock Individual Corporate DirectorBoard Member Jan 1, 2022
Janice Cramer Individual Corporate Director Apr 11, 2025
Operational/Managerial Control Aug 1, 2025
Tom Herrin Individual Corporate DirectorBoard Member Jan 1, 2020
Eric Neal Individual Corporate OfficerCeo Aug 26, 2025
W-2 Managing EmployeeAd; Aug 25, 2025
Wes McMahan Individual Corporate DirectorBoard Member Jan 1, 2020

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Arbor Health Morton HospitalMorton, WA, CCN 501319 Hospital Operational/Managerial Control Dec 2, 1976
Arbor Health Morton HospitalMorton, WA, CCN 50Z319 Hospital Operational/Managerial Control Dec 2, 1976
Arbor Health Randle ClinicRandle, WA, CCN 508511 Rural health clinic Other Dec 2, 1976
Arbor Health Packwood ClinicPackwood, WA, CCN 508597 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2023
Apr 1, 2023

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764806400000",
    "number": "1205110830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1138",
            "city": "MORTON",
            "state": "WA",
            "postal_code": "983560019",
            "telephone_number": "360-496-3702",
            "fax_number": "360-983-3098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 WILLIAMS STREET",
            "city": "MOSSYROCK",
            "state": "WA",
            "postal_code": "98564",
            "telephone_number": "360-983-8990",
            "fax_number": "360-983-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY HOSPITAL DISTRICT NO 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-30",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A",
        "authorized_official_last_name": "CRAMER",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "360-496-5112"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WA",
            "license": "H173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arbor Health Mossyrock Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mossyrock, WA

Sources for this page

Verify at the official NPI Registry.