NPIMap

Organization Active NPI

Community Health Center of Snohomish County

  • Community Health Clinic/Center
  • Everett, WA
National Provider Identifier
1548786296
Registry record updated Aug 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Practice address
4201 Rucker Ave
Everett, WA 98203-2237
Phone
(425) 789-3700
NPI assigned
Aug 15, 2017
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 15, 2017

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

Authorized official

Name
Mr. Robert C Farrell
Title
Ceo
Phone
(425) 789-3716

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

4201 Rucker Ave
Everett, WA 98203-2237

Mailing address

8609 Evergreen Way
Everett, WA 98208-2619
Phone (425) 789-3700

Other identifiers 1

IdentifierTypeStateIssuer
1017523MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180411001645 WA Part A Provider - Federally Qualified Health Center (FQHC) 0446152003 Practice locations: Everett, WA

Federally qualified health center certification: CCN 941037

Legal name
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2018
Last certification
Mar 1, 2018
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 1984 in WA
Enrollment address
4201 Rucker Ave
Ste 1
Everett, WA 98203-2237

Other NPIs with the same Medicare PAC ID 17

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

View all 17

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center28 organizations share this tax ID, including this one
Part of
Community Health Center

Other organizations with this tax ID 27

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

View all 27

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Julian King Individual Corporate DirectorBoard Member Jan 1, 2020
Dion C Kapetanov Individual W-2 Managing EmployeeCao Dec 1, 2010 100%
Joseph E Vessey Individual Corporate OfficerCeo Jul 1, 2019
W-2 Managing EmployeeCeo Jul 1, 2019
Tracy Cuajao Individual Corporate DirectorDirector Sep 1, 2016
Robert Maxwell Individual Corporate DirectorBoard Member Jan 1, 2020
Sue M Yoon Individual Corporate DirectorDirector of Dental Services Aug 2, 2010
Sandra Toussaint Individual Corporate DirectorBoard Member Jan 1, 2020
Tove Doyle-Skaftun Individual Corporate OfficerChief Nursing Officer Jan 26, 2004
Charles Mister Individual Corporate DirectorBoard Member Jan 1, 2020
Edward Rogan Individual Corporate DirectorBoard Member Dec 1, 2016
Olivia D Mathisen-Holloman Individual Corporate DirectorDirector - Board Chair Dec 1, 2017
Joel a Emery Individual Corporate OfficerCfo Feb 5, 2024
W-2 Managing EmployeeCfo Feb 5, 2024
Jessica Enick Individual Corporate DirectorBoard Member Jan 1, 2020
Lenora Rose Individual Corporate DirectorDirector Aug 1, 2015

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502755200000",
    "number": "1548786296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8609 EVERGREEN WAY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982082619",
            "telephone_number": "425-789-3700",
            "fax_number": "425-789-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 RUCKER AVE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982032237",
            "telephone_number": "425-789-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY",
        "enumeration_date": "2017-08-15",
        "last_updated": "2017-08-15",
        "status": "A",
        "authorized_official_last_name": "FARRELL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-789-3716",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017523",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

Verify at the official NPI Registry.