Basic Information
| Provider Information | |||||||||
| NPI: | 1881642239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 MILLER STREET | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096621511 | ||||||||
| FaxNumber: | 5096656081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 S MILLER ST | ||||||||
| Address2: | |||||||||
| City: | WENATCHEE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 988013201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096621511 | ||||||||
| FaxNumber: | 5096656081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5096638711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTRAL WASHINGTON HEALTH SERVICES ASSOCIATION | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Case Management | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 8919703 | 01 | WA | L & I CRIME VICTIMS | OTHER | 7066699 | 05 | WA | MEDICAID | 81780 | 01 | WA | L & I | OTHER |