NPIMap

Organization Active NPI

Great Rivers Behavioral Health Organization

  • Community/Behavioral Health Agency
  • Chehalis, WA
National Provider Identifier
1285155366
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
603564565 Issued in WA
Legal business name
GREAT RIVERS BEHAVIORAL HEALTH ORGANIZATION
Practice address
57 W Main Street
Suite 260
Chehalis, WA 98532
Phone
(360) 795-5955
Fax
(360) 740-8099
NPI assigned
Jun 29, 2017
Organization subpart
Yes
Parent organization
GREAT RIVERS BEHAVIORAL HEALTH ORGANIZATIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Mr. Marc Edmund Bollinger, LICSW
Title
Administrator
Phone
(360) 795-5955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 603564565 WA Primary

Addresses

Primary practice location

57 W Main Street
Suite 260
Chehalis, WA 98532

Mailing address

PO Box 1447
Chehalis, WA 98532
Phone (360) 795-5955

Other identifiers 1

IdentifierTypeStateIssuer
200458MedicaidWA

Other names 3

  • Great Rivers Behavior Health Agency Doing business as
  • Great Rivers Behavior Health Agency dba Community Doing business as
  • Great Rivers Behavior Health Agency dba Community Integrated Health Services Doing business as

National Provider Directory

National Provider Directory
Part of
Great Rivers Behavioral Health Organization

Locations

57 W Main St
Ste 260
Chehalis, WA 98532
Phone (360) 795-5955

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1285155366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1447",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "98532",
            "telephone_number": "360-795-5955",
            "fax_number": "360-740-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 W MAIN STREET",
            "address_2": "SUITE 260",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "98532",
            "telephone_number": "360-795-5955",
            "fax_number": "360-740-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT RIVERS BEHAVIORAL HEALTH ORGANIZATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT RIVERS BEHAVIORAL HEALTH ORGANIZATI",
        "enumeration_date": "2017-06-29",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "BOLLINGER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "EDMUND",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-795-5955",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "603564565",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200458",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Rivers Behavior Health Agency",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Rivers Behavior Health Agency dba Community",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Great Rivers Behavior Health Agency dba Community Integrated Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chehalis, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.