Basic Information
| Provider Information | |||||||||
| NPI: | 1437418175 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEWIS COUNTY COMMUNITY HEALTH SERVICES | ||||||||
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| OtherOrganizationName: | VALLEY VIEW HEALTH CENTER - WALK IN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2690 NE KRESKY AVE | ||||||||
| Address2: | |||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985322412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603309595 | ||||||||
| FaxNumber: | 3603309560 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 COOKS HILL RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | CENTRALIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985319162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607363042 | ||||||||
| FaxNumber: | 3607362967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2012 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| AuthorizedOfficialLastName: | CLARK | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3603309595 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEWIS COUNTY COMMUNITY HEALTH SERVICES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | G8801670 | 01 | WA | MEDICARE GROUP | OTHER |