NPIMap

Organization Active NPI

Community Health of Central Washington

Doing business as CHCW Mobile Van

  • Federally Qualified Health Center (FQHC)
  • Ellensburg, WA
National Provider Identifier
1043024714
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH OF CENTRAL WASHINGTON
Doing business as
CHCW Mobile Van
Practice address
521 E Mountain View Ave
Ellensburg, WA 98926-3865
Phone
(509) 494-6700
NPI assigned
Feb 4, 2025
Last updated
Jan 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela Gonzalez
Title
Cfo
Phone
(509) 494-6700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

521 E Mountain View Ave
Ellensburg, WA 98926-3865

Mailing address

501 S 5TH Ave
Yakima, WA 98902-3550
Phone (509) 494-6700

Other practice location 1

1806 W Lincoln Ave
Yakima, WA 98902-2473
Phone (509) 452-4520

Other identifiers 1

IdentifierTypeStateIssuer
7118276MedicaidWA

Other names 1

  • CHCW Mobile Van Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260218001570 WA Part A Provider - Federally Qualified Health Center (FQHC) 4183536931 Practice locations: Yakima, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043024714. Details of each certification follow.

Federally qualified health center certification: CCN 501080

Legal name
COMMUNITY HEALTH OF CENTRAL WASHINGTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 26, 2026
Last certification
Feb 26, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
501 S 5TH Ave
Yakima, WA 98902-3550

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Community Health of Central14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

521 E Mountain View Ave
Ellensburg, WA 98926
Phone (509) 962-1414

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lisa Martin Individual W-2 Managing EmployeeProvider Relations Jan 19, 2004
Angela Gonzalez Individual Corporate OfficerCeo Aug 19, 2019 100%
Desiree Ashbrooks Individual Corporate OfficerCfo Sep 1, 2021

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768435200000",
    "number": "1043024714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S 5TH AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023550",
            "telephone_number": "509-494-6700",
            "fax_number": "509-573-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E MOUNTAIN VIEW AVE",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989263865",
            "telephone_number": "509-494-6700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1806 W Lincoln Ave",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989022473",
            "country_code": "US",
            "telephone_number": "509-452-4520",
            "fax_number": "509-452-5224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY HEALTH OF CENTRAL WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-04",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "509-494-6700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7118276",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHCW Mobile Van",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellensburg, WA

Sources for this page

Verify at the official NPI Registry.