COWLITZ FAMILY HEALTH CENTER (NPI# 1104243534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104243534 |
| Entity Type | Organization |
| Organization Name | COWLITZ FAMILY HEALTH CENTER |
| Practice Address |
621 Grade St Kelso WA 98626-2606 |
| Mailing Address |
1057 12th Ave Longview WA 98632-2509 |
| Practice Telephone | 3606363892 |
| Practice Fax Number | 3602328400 |
| Mailing Telephone | 3606363892 |
| Mailing Fax Number | 3602328400 |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2020-10-26 |
| Authorized Official Name | DIAN J COOPER (CEO) |
| Authorized Official Telephone | 3606363892 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053472993 | Cowlitz Family Health Center | Clinic/Center | 1251 Lewis River Rd Ste D, Woodland, WA 98674-9203 | 2006-12-13 |
| 1962876748 | Cowlitz Family Health Center | Clinic/Center | 784 14th Ave, Longview, WA 98632-2315 | 2015-11-17 |
| 1801266481 | Cowlitz Family Health Center | Clinic/Center | 139 1st Ave Sw, Castle Rock, WA 98611 | 2015-09-25 |
| 1376910885 | Cowlitz Family Health Center | Community/Behavioral Health | 1057 12th Ave, Longview, WA 98632-2509 | 2015-09-01 |
| 1366790008 | Cowlitz Family Health Center | Clinic/Center | 300 Oak St Ste B, Kelso, WA 98626-2304 | 2012-08-28 |
| 1538497417 | Cowlitz Family Health Center | Clinic/Center | 335 Una Ave, Cathlamet, WA 98612-9583 | 2009-12-03 |
| 1184824203 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
| 1437359551 | Cowlitz Family Health Center | Case Management | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
| 1700086824 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-18 |
| 1073711081 | Cowlitz Family Health Center | Clinic/Center | 1057 12th Ave, Longview, WA 98632-2509 | 2007-07-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | COWLITZ FAMILY HEALTH CENTER | 1057 12th Ave, Longview, WA 98632-2509 |
| Street Address |
621 GRADE ST |
| City | KELSO |
| State | WA |
| Zip Code | 98626-2606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750612123 | Cristina Duvall | Counselor | 621 Grade St, Kelso, WA 98626-2606 | 2010-01-24 |
| 1063933406 | Julia A Spalding | Counselor | 621 Grade St, Kelso, WA 98626-2606 | 2017-07-06 |
| 1295113744 | Amber Delagrange | Counselor | 621 Grade St, Kelso, WA 98626-2606 | 2015-05-15 |
| 1083092548 | Deborah Smith | Counselor | 621 Grade St, Kelso, WA 98626-2606 | 2015-05-15 |
| 1215323977 | Michelle Buckholz | Counselor | 621 Grade St, Kelso, WA 98626-2606 | 2015-04-09 |
| 1609266717 | Rama Mitchell Jr. | Counselor | 621 Grade St, Kelso, WA 98626-2606 | 2015-01-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730581877 | Wrothell Funchess | Counselor | 1645 Bowmont Ave, Kelso, WA 98626 | 2014-09-19 |
| 1427457688 | Julie Dalen | Counselor | 309 Oak Street, Kelso, WA 98626 | 2014-08-13 |
| 1033468822 | Rene Kerry Bohannon-oxford | Counselor | 2707 Pacific Ave North, Kelso, WA 98626 | 2012-09-07 |
| 1447535737 | Nichole Kathleen Allee | Massage Therapist | 109 Nw 1st St., Kelso, WA 98626 | 2011-10-18 |
| 1689991655 | Zachariah Kramer | Radiology | 700 Lincoln Street Suite 100, Longview Radiologists, Kelso, WA 98626 | 2010-04-29 |
| 1508007071 | Robert Lee Blair | Registered Nurse | 119 Blackburn Lane, Kalama, WA 98626 | 2009-03-13 |
| 1942318829 | Imholte & Anderson Pllc | Dentist | 409 West Main Street, Kelso, WA 98626 | 2006-08-29 |
| 1922088723 | James Bevan Hollingsworth | Pharmacist | 204 S Pacific Ave, Kelso, WA 98626 | 2006-01-18 |
| 1972021087 | Adreia Jenice Jessop | Registered Nurse | 300 Oak St, Kelso, WA 98626 | 2017-09-08 |
| 1023567310 | Charlene Han | Pharmacist | 205 Three Rivers Dr, Kelso, WA 98626 | 2016-09-27 |
| Find all providers in zip 98626 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134373574 | C & R Executives, LLC | Clinic/Center | 309 Oak St, Kelso, WA 98626-2340 | 2008-11-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275145682 | Sea Mar Community Health Centers | Clinic/Center | 4100 194th St Sw Ste 120, Lynnwood, WA 98036-4613 | 2020-08-18 |
| 1386278372 | Social Treatment Opportunity Programs II, Inc | Clinic/Center | 600 S 1st Ave, Othello, WA 99344-1703 | 2020-02-27 |
| 1326672692 | Excelsior Integrated Care Center LLC | Clinic/Center | 3910 W. Indian Trail Rd, Spokane, WA 99208-4739 | 2020-02-26 |
| 1659919561 | Baart Behavioral Health Services, Inc. | Clinic/Center | 716 S Chase St, Port Angeles, WA 98362-6122 | 2019-12-11 |
| 1346888260 | Baart Behavioral Health Services, Inc. | Clinic/Center | 1520 Ne Riddell Rd Ste 110, Bremerton, WA 98310-3005 | 2019-12-11 |
| 1437634730 | Hazelden Betty Ford Foundation | Clinic/Center | 1231 116th Ave. Ne Suite 410, Bellevue, WA 98004 | 2018-10-02 |
| 1780174441 | American Behavioral Health Systems, Inc. | Clinic/Center | 715 E Sprague Ave Ste 107, Spokane, WA 99202-2142 | 2018-05-17 |
| 1598255267 | American Behavioral Healt Systems, Inc. | Clinic/Center | 7208 267th St Nw Ste A-100, Stanwood, WA 98292-6289 | 2018-05-17 |
| 1437648136 | American Behavioral Health Systems, Inc. | Clinic/Center | 8625 Evergreen Way Ste 100, Everett, WA 98208-2620 | 2018-05-08 |
| 1487143350 | Steve Parker | Clinic/Center | 1206 State Ave Ste H, Marysville, WA 98270-3645 | 2018-05-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.