NPIMap

Cowlitz Family Health Center

Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Kelso, WA

NPI 1104243534 · NPPES record last updated May 31, 2022

Key facts

NPI
1104243534
Entity type
Organization (NPI type 2)
Primary specialty
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Legal business name
COWLITZ FAMILY HEALTH CENTER
Practice address
621 Grade St
Kelso, WA 98626-2606
Phone
(360) 636-3892
Fax
(360) 232-8400
NPI assigned
Mar 24, 2014
Organization subpart
No

Authorized official

Name
James J Coffee
Title
Ceo
Phone
(360) 636-3892

Corporate family (same tax ID) 13

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

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Tax ID family
NB North Beach Clinic (14 organizations share this tax ID)

Locations

2232 S Silver Lake Rd
Castle Rock, WA 98611
Phone (360) 274-3262

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Yes

Addresses

Primary practice location

621 Grade St
Kelso, WA 98626-2606

Mailing address

1057 12TH Ave
Longview, WA 98632-2509
Phone (360) 636-3892

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 31, 2022.

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1104243534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-636-3892",
            "fax_number": "360-232-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 GRADE ST",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986262606",
            "telephone_number": "360-636-3892",
            "fax_number": "360-232-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWLITZ FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-24",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "COFFEE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-636-3892"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kelso, WA

All providers in Kelso, WA · Substance Use Disorder Rehabilitation Clinic/Center in Washington

Sources for this page

Verify at the official NPI Registry.