NPIMap

Klickitat County Public Hospital District No 1

Organization Active NPI Community Based Hospice Care Agency · Goldendale, WA

NPI 1851477061 · NPPES record last updated Dec 27, 2013

Key facts

NPI
1851477061
Entity type
Organization (NPI type 2)
Primary specialty
Community Based Hospice Care Agency 251G00000X
License
202000768 (WA)
Legal business name
KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Practice address
310 S Roosevelt Ave
Goldendale, WA 98620-9201
Phone
(509) 773-4022
Fax
(509) 773-1941
NPI assigned
Oct 31, 2006
Organization subpart
No

Authorized official

Name
Mrs. Leslie Hiebert
Title
Ceo
Phone
(509) 773-4022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 4

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

Corporate family (same tax ID) 6

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 47

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 47

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Hospice

Listed as
Klickitat Valley Health CCN 501539
Ownership
Government
Certified
Aug 10, 2005
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WA

Hospice certification: CCN 501539

Legal name
KLICKITAT COUNTY PUBLIC HOSPITAL DISTRICT NO 1
Doing business as
KLICKITAT VALLEY HEALTH
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 10, 2005
Last certification
Jan 22, 2021
Ownership / control type
Government - County
Organization structure
Corporation · Non-profit
Incorporated
Jan 1, 1941 in WA
Enrollment address
310 S Roosevelt St
Goldendale, WA 98620-9201

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Larry Hoctor
Individual 		Corporate Director Jan 15, 2020
Ronald Ihrig
Individual 		Corporate Director Jan 3, 2022
Klickitat County Public Hospital District No 1
Organization · Goldendale, WA
Non-profit 		Operational/Managerial Control Apr 4, 2005
Jonathan Hatfield
Individual 		Corporate Officer Oct 7, 2023
W-2 Managing Employee Sep 6, 2005
Mary Pond
Individual 		Corporate Director Jan 1, 2014
Crystal Scott
Individual 		Corporate Director May 1, 2019
Mark Sigfrinius
Individual 		Corporate Director
Director		 Jan 1, 2018
Jamie L Slater
Individual 		Corporate Director
Director of Finance		 Apr 21, 2017
W-2 Managing Employee
Director of Finance		 Jan 1, 2017
Lori Groves
Individual 		Corporate Officer
Cfo		 Dec 1, 2020
W-2 Managing Employee Dec 1, 2020

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
KVH Family Medicine
Goldendale, WA · CCN 508519		 Rural health clinic Operational/Managerial Control Jan 1, 1986

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20090223000482 WA Part a Provider - Hospice 0648164269 Practice locations: Goldendale, WA

National Provider Directory

Tax ID family
Family Pracitice Clinic (7 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 202000768 WA Yes

Addresses

Primary practice location

310 S Roosevelt Ave
Goldendale, WA 98620-9201

Mailing address

310 S Roosevelt Ave
Goldendale, WA 98620-9201
Phone (509) 773-4022

Other names

  • KLICKITAT VALLEY HEALTH Doing business as

Other providers in Goldendale, WA

All providers in Goldendale, WA · Community Based Hospice Care Agency in Washington

Sources for this page

Verify at the official NPI Registry.