COWLITZ FAMILY HEALTH CENTER (NPI# 1962876748) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962876748 |
| Entity Type | Organization |
| Organization Name | COWLITZ FAMILY HEALTH CENTER |
| Other Organization Name | FAMILY HEALTH CENTER 14TH AVE |
| Practice Address |
784 14th Ave Longview WA 98632-2315 |
| Mailing Address |
1057 12th Ave Longview WA 98632-2509 |
| Practice Telephone | 3607036400 |
| Practice Fax Number | 3603533611 |
| Mailing Telephone | 3606363892 |
| Mailing Fax Number | 3602328400 |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2020-05-20 |
| Authorized Official Name | DIAN COOPER (CEO) |
| Authorized Official Telephone | 3606363892 |
| Is Organization Subpart | Y |
| Parent Organization Name | COWLITZ FAMILY HEALTH CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QF0050X |
Clinic/Center Specialization: Family Planning, Non-Surgical |
600176084 | WA | Ambulatory Health Care Facilities |
| N | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
600176084 | WA | Ambulatory Health Care Facilities |
| N | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
600176084 | WA | Ambulatory Health Care Facilities |
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
600176084 | WA | Ambulatory Health Care Facilities |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
600176084 | WA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 1437359551 | 05 | |
| WA | 7086523 | 05 |
| Other Name | Type Code |
|---|---|
| Family Health Center 14th Ave | Doing Business As Name - Organization |
| 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 |
| 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 |
| 1104243534 | Cowlitz Family Health Center | Clinic/Center | 621 Grade St, Kelso, WA 98626-2606 | 2014-03-24 |
| 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 |
784 14TH AVE |
| City | LONGVIEW |
| State | WA |
| Zip Code | 98632-2315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083605778 | Daryl William Linnell | Pediatrics | 784 14th Ave, Longview, WA 98632-2315 | 2005-11-02 |
| 1750851846 | Irene Mudehwe | Nurse Practitioner | 784 14th Ave, Longview, WA 98632-2315 | 2018-11-30 |
| 1467940486 | Jeb Bolerjack | Counselor | 784 14th Ave, Longview, WA 98632-2315 | 2018-04-25 |
| 1619418159 | Megan Minthorn | Registered Nurse | 784 14th Ave, Longview, WA 98632-2315 | 2017-03-16 |
| 1821340530 | Seth Mercurio | Nurse Practitioner | 784 14th Ave, Longview, WA 98632-2315 | 2012-10-04 |
| 1538357223 | Faith Ann Wilfley | Pediatrics | 784 14th Ave, Longview, WA 98632-2315 | 2007-10-09 |
| 1639287188 | Pediatric Clinic, Inc., P.s. | Clinic/Center | 784 14th Ave, Longview, WA 98632-2315 | 2006-08-25 |
| 1043238033 | Jan Carlin Khouri | Nurse Practitioner | 784 14th Ave, Longview, WA 98632-2315 | 2006-07-17 |
| 1538147764 | Forrest G Mcgriff | Nurse Practitioner | 784 14th Ave, Longview, WA 98632-2315 | 2006-01-06 |
| 1598756967 | Karen Sachiko Kato | Pediatrics | 784 14th Ave, Longview, WA 98632-2315 | 2005-11-03 |
| Find all providers in the same location | ||||
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|---|---|---|---|---|
| 1851992366 | Honor Senior Care LLC | Home Health Aide | 1135 3rd Ave, Ste S101, Longview, WA 98632 | 2020-11-03 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1053870717 | Matthew Johnson | Physician Assistant | 900 Ocean Beach Hwy Ste 110, Longview, WA 98632 | 2019-03-12 |
| 1295205367 | Abid Valji | Occupational Therapist | Americana Health and Rehabilitation Center, 917 7th Ave, Longview, WA 98632 | 2018-11-30 |
| 1184106437 | Peacehealth | Durable Medical Equipment & Medical Supplies | Triangle Mall Suite 16 1015 Ocean Beach Hwy, Longview, WA 98632 | 2018-09-04 |
| 1982186318 | Linda Joan Mason | Licensed Practical Nurse | 1153 23rd Ave, Longview, WA 98632 | 2018-09-01 |
| 1891291910 | Ellen Sumner Hornbeak | Physical Therapist | 200 Triangle Shopping Ctr Ste 270, Longview, WA 98632 | 2018-04-05 |
| 1700399961 | Johnna Joyce Knapp | Speech-Language Pathologist | 2615 Lilac St, Longview, WA 98632 | 2017-11-09 |
| 1841711868 | Deborah Annette Burzynski | Registered Nurse | 1057 12th Avenue, Longview, WA 98632 | 2017-06-29 |
| 1598291122 | Cheyenne West | Counselor | 1616 10th Avenue, Longview, WA 98632 | 2017-05-02 |
| Find all providers in zip 98632 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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|---|---|---|---|---|
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| 1417476284 | Longview Wellness Center Inc | Clinic/Center | 1107 E Marshall Ave Bldg 3, Longview, TX 75601-5602 | 2017-09-13 |
| 1770122681 | Longview Wellness Center, Inc. | Clinic/Center | 705 E Marshall Ave Ste 3000, Longview, TX 75601-5661 | 2019-12-26 |
| 1891280277 | Special Health Resources for Texas Incorporated | Clinic/Center | 705 E Marshall Ave Ste 3000, Longview, TX 75601-5661 | 2018-06-27 |
| 1740783620 | Special Health Resources for Texas, Incorporated | Clinic/Center | 1300 N 6th St, Longview, TX 75601-5567 | 2018-03-16 |
| 1922556067 | Special Health Resources for Texas, Inc | Clinic/Center | 402 N 7th St, Longview, TX 75601-6704 | 2016-09-19 |
| 1750769238 | Special Health Resources for Texas Incorporated | Clinic/Center | 703 E Marshall Ave, Suite 310, Longview, TX 75601-5500 | 2015-05-15 |
| 1669872560 | East Texas Border Health Clinic | Clinic/Center | 2131 S Mobberly Ave, Longview, TX 75602-3563 | 2014-08-27 |
| 1184824203 | Cowlitz Family Health Center | Clinic/Center | 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 |
| Find all providers in LONGVIEW | ||||
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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.