NPIMap

Organization Active NPI

Community Health Center of Snohomish County

  • Federally Qualified Health Center (FQHC)
  • Arlington, WA
National Provider Identifier
1649602756
Registry record updated Mar 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Practice address
326 S Stillaguamish Ave
Arlington, WA 98223-1652
Phone
(360) 572-5400
Fax
(360) 572-5401
NPI assigned
Jul 31, 2013
Last updated
Mar 25, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 25, 2016

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

Authorized official

Name
Robert C Farrell
Title
Ceo
Phone
(425) 789-3717

Specialties & licenses 1

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

Addresses

Primary practice location

326 S Stillaguamish Ave
Arlington, WA 98223-1652

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1730136367OtherORGANIZATION NPI
1017523MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140411001710 WA Part A Provider - Federally Qualified Health Center (FQHC) 0446152003 Practice locations: Arlington, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649602756. Details of each certification follow.

Federally qualified health center certification: CCN 501967

Legal name
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2014
Last certification
Apr 15, 2014
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 1984 in WA
Enrollment address
326 S Stillaguamish Ave
Arlington, WA 98223-1652

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
Comm HLTH Ctr Snohomis Cty29 organizations share this tax ID, including this one
Part of
Comm HLTH Ctr Snohomis Cty

Other organizations with this tax ID 28

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

View all 28

Ownership & related parties

All disclosed owners & managing parties 10

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 Officer Jul 1, 2021
Dion C Kapetanov Individual Corporate OfficerCao Mar 13, 2014
W-2 Managing EmployeeCao Mar 13, 2014
Joseph E Vessey Individual Corporate Officer Jul 1, 2019
W-2 Managing Employee Jul 1, 2019
Robert Maxwell Individual Corporate Officer Jul 1, 2021
Sandra Toussaint Individual Corporate Officer Jul 1, 2021
Charles Mister Individual Corporate Officer Jul 1, 2021
Edward Rogan Individual Corporate Director Dec 1, 2016
Olivia D Mathisen-Holloman Individual Corporate Officer Jul 1, 2021
Joel a Emery Individual Corporate OfficerCfo Feb 5, 2024
W-2 Managing EmployeeCfo Feb 5, 2024
Jessica Enick Individual Corporate Officer Jul 1, 2021

NPI Registry JSON

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

{
    "created_epoch": "1375228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458864000000",
    "number": "1649602756",
    "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": "326 S STILLAGUAMISH AVE",
            "city": "ARLINGTON",
            "state": "WA",
            "postal_code": "982231652",
            "telephone_number": "360-572-5400",
            "fax_number": "360-572-5401"
        }
    ],
    "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": "2013-07-31",
        "last_updated": "2016-03-25",
        "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": "425-789-3717"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION NPI",
            "identifier": "1730136367",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1017523",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, WA

Sources for this page

Verify at the official NPI Registry.