Basic Information
| Provider Information | |||||||||
| NPI: | 1376696096 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EUGENIA CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1371 | ||||||||
| Address2: | |||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607409767 | ||||||||
| FaxNumber: | 3602626620 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 NORTH MARKET BLVD, STE C | ||||||||
| Address2: | |||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609480203 | ||||||||
| FaxNumber: | 3602626620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | FABIOLA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3602665585 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 324500000X | WA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 1009072 | 05 | WA | MEDICAID |