NPIMap

Organization Active NPI

Cowlitz Family Health Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Kelso, WA
National Provider Identifier
1104243534
Registry record updated May 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 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
Last updated
May 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2022

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

Authorized official

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

Specialties & licenses 2

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

Addresses

Primary practice location

621 Grade St
Kelso, WA 98626-2606

Mailing address

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

National Provider Directory

National Provider Directory
Tax ID family
NB North Beach Clinic14 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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.