NPIMap

Organization Active NPI

Lewis County Community Health Services

Doing business as Valley View Health Center - Community Youth Services Olympia

  • Federally Qualified Health Center (FQHC)
  • Olympia, WA
National Provider Identifier
1124739974
Registry record updated Dec 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LEWIS COUNTY COMMUNITY HEALTH SERVICES
Doing business as
Valley View Health Center - Community Youth Services Olympia
Practice address
914 7TH Ave SE Ste B
Olympia, WA 98501-1548
Phone
(360) 236-7166
Fax
(360) 529-8070
NPI assigned
Dec 12, 2022
Last updated
Dec 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2022

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

Authorized official

Name
Gaelon B Spradley
Title
Ceo
Phone
(360) 330-9595

Specialties & licenses 1

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

Addresses

Primary practice location

914 7TH Ave SE Ste B
Olympia, WA 98501-1548

Mailing address

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

Other names 1

  • Valley View Health Center - Community Youth Services 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…
O20230125002335 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 1124739974. Details of each certification follow.

Federally qualified health center certification: CCN 501019

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
Feb 23, 2023
Last certification
Feb 23, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 3, 2004 in WA
Enrollment address
914 7TH Ave SE
Ste B
Olympia, WA 98501-1548

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
Tax ID family
Lewis Cnty Comm Health Serv16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

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
Bobby D Burger Individual Corporate DirectorBoard Member Mar 22, 2021
Robert C Mohrbacher Individual Corporate OfficerBoard Treasurer Oct 24, 2022
Corporate DirectorBoard Member Jan 27, 2020
Mary E Harrington Individual Corporate DirectorBoard Member Feb 28, 2022
Daniel I Stusser Individual Corporate OfficerBoard Secretary Jan 27, 2020
Corporate DirectorBoard Member Jan 27, 2020
Robert Rust Individual Corporate DirectorBoard Member Mar 22, 2021
Rachel C Wood Individual Corporate OfficerBoard Vice President Apr 27, 2020
Corporate DirectorBoard Member Apr 27, 2020
Lewis County Community Health Services Organization, Chehalis, WA 5% Or Greater Direct Ownership Interest Jan 1, 2023 100%
Greg S Martin Individual Corporate OfficerBoard President Nov 3, 2014
Corporate DirectorBoard Member Nov 3, 2014
Toni R Gwin Individual Corporate DirectorBoard Member Feb 25, 2013
Gaelon B Spradley Individual Corporate OfficerCeo May 1, 2019
W-2 Managing EmployeeCeo May 1, 2019 100%
Operational/Managerial ControlCeo May 1, 2019 100%
Tamra Ruymann Individual Corporate DirectorBoard Member Oct 24, 2022
Holly K Sliva Individual Corporate OfficerCfo 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 CenterOlympia, WA, CCN 501954 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 12, 2013
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 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 8

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": "1670803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670803200000",
    "number": "1124739974",
    "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": "914 7TH AVE SE STE B",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985011548",
            "telephone_number": "360-236-7166",
            "fax_number": "360-529-8070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-12",
        "last_updated": "2022-12-12",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "SPRADLEY",
        "authorized_official_first_name": "GAELON",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-330-9595"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley View Health Center - Community Youth Services Olympia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.