NPIMap

Organization Active NPI

Lewis County Community Health Services

Doing business as Valley View Health Center - Olympia

  • Federally Qualified Health Center (FQHC)
  • Olympia, WA
National Provider Identifier
1104265925
Registry record updated Mar 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
602-312-048 Issued in WA
Legal business name
LEWIS COUNTY COMMUNITY HEALTH SERVICES
Doing business as
Valley View Health Center - Olympia
Practice address
3775 Martin Way E
Suite a
Olympia, WA 98506-5007
Phone
(360) 236-7166
Fax
(360) 529-8070
NPI assigned
Jun 14, 2013
Last updated
Mar 31, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2016

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

Authorized official

Name
Steven C Clark
Title
Executive Director
Phone
(360) 330-9595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 602-312-048 WA Primary

Addresses

Primary practice location

3775 Martin Way E
Suite a
Olympia, WA 98506-5007

Mailing address

2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595

Other identifiers 1

IdentifierTypeStateIssuer
G8801670OtherWAMEDICARE GROUP

Other names 1

  • Valley View Health Center - Olympia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040426001899 WA Part B Supplier - Clinic/Group Practice 6002803749 Receives reassigned benefits from 82 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winlock, WA; Toledo, WA; Tenino, WA; Raymond, WA; Pe Ell, WA; Onalaska, WA; Olympia, WA; Centralia, WA…
O20131127001776 WA Part A Provider - Federally Qualified Health Center (FQHC) 6002803749 Practice locations: Olympia, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104265925. Details of each certification follow.

Federally qualified health center certification: CCN 501954

Legal name
LEWIS COUNTY COMMUNITY HEALTH SERVICES
Doing business as
VALLEY VIEW HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 27, 2013
Last certification
Sep 27, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 3, 2004 in WA
Enrollment address
3775 Martin Way E
Suite a
Olympia, WA 98506-5007

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Gricelda Sanchez Individual Corporate DirectorBoard Member Feb 27, 2017
Bobby D Burger Individual Corporate DirectorBoard Member Mar 22, 2021
Robert C Mohrbacher Individual Corporate DirectorBoard Member Jan 27, 2020
Kiandre Brasher Individual Corporate OfficerTreasurer Feb 27, 2017
Corporate DirectorBoard Member Feb 27, 2017
Daniel I Stusser Individual Corporate OfficerSecretary Jan 27, 2020
Corporate DirectorBoard Member Jan 27, 2020
Robert Rust Individual Corporate DirectorBoard Member Mar 22, 2021
Rachel C Wood Individual Corporate OfficerVice President Oct 25, 2021
Corporate DirectorBoard Member Apr 27, 2020
Lewis County Community Health Services Organization, Chehalis, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 12, 2013 100%
Greg S Martin Individual Corporate OfficerPresident Jan 1, 2021
Corporate DirectorBoard Member Nov 3, 2014
Toni R Gwin Individual Corporate DirectorBoard Member Feb 25, 2013
Gaelon B Spradley Individual Corporate OfficerChiel Executive Officer Apr 28, 2019 100%
W-2 Managing EmployeeCeo Apr 28, 2019 100%
Operational/Managerial ControlCeo Apr 28, 2019 100%
Holly K Sliva Individual Corporate OfficerChief Financial Officer Sep 23, 2013
W-2 Managing EmployeeCfo Sep 23, 2013

Owners & managing parties with NPI records 12

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Valley View Health CenterCentralia, WA, CCN 501925 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 24, 2013
Valley View Health CenterRaymond, WA, CCN 501926 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 26, 2010
Lewis County Community Health ServicesOnalaska, WA, CCN 501896 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 8, 2006
Valley View Health CenterPe Ell, WA, CCN 501939 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 3, 2012
Valley View Health CenterCentralia, WA, CCN 501972 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 2, 2014
Valley View Health CenterTenino, WA, CCN 941030 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2017
Valley View Health CenterOlympia, WA, CCN 501019 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
Valley View Health CenterChehalis, WA, CCN 501041 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2023

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 8

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

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": "1371168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459382400000",
    "number": "1104265925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322412",
            "telephone_number": "360-330-9595",
            "fax_number": "360-330-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 MARTIN WAY E",
            "address_2": "SUITE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065007",
            "telephone_number": "360-236-7166",
            "fax_number": "360-529-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-14",
        "last_updated": "2016-03-31",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-330-9595"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": "602-312-048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "G8801670",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley View Health Center - Olympia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.