Lewis County Community Health Services
Organization Active NPI Federally Qualified Health Center (FQHC) · Winlock, WA
NPI 1689933459 · NPPES record last updated Jan 4, 2019
Key facts
- NPI
- 1689933459
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- LEWIS COUNTY COMMUNITY HEALTH SERVICES
- Practice address
- 100 Cedar Crest Dr
Winlock, WA 98596-9791 - Phone
- (360) 785-9400
- Fax
- (360) 785-0236
- NPI assigned
- May 14, 2012
- Organization subpart
- Yes
- Parent organization (as reported)
- LEWIS COUNTY COMMUNITY HEALTH SERVICES, INC.
Authorized official
- Name
- Steven Clark
- Title
- Executive Director
- Phone
- (360) 330-9595
Owned or controlled facilities with NPI records 10
Other NPIs on the same Medicare enrollment 14
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 15
Practitioners 35
-
Erik Steven Plantiko, PA-C
-
Soo Ryun Ahn, MD
-
Nicole Marie Allen, ARNP
-
Bryan Neil Blumer, PA-C
-
Austin James Chamberlain, PA-C
-
Thomas R Cooke, D.O.
-
Heather Ann Day, APNP
-
Sarah Frances Landrum, M.D.
-
David E Little, DO
-
Jacob John Massarelli, PA-C
-
Faith Mmborothi, ARNP
-
Saif Naji, FNP
-
Heather Dawn Novak, FNP-BC
-
Daniel Payton, PA-C
-
Kimberly G Sales, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WA
Federally qualified health center certification: CCN 501898
- 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
- May 8, 2006
- Last certification
- May 8, 2006
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 18, 2003 in WA
- Enrollment address
- 100 Cedar Crest Dr
Winlock, WA 98596-9791
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Gricelda Sanchez |
Corporate Director |
Feb 27, 2017 | |
| Bobby D Burger |
Corporate Director |
Mar 22, 2021 | |
| Robert C Mohrbacher |
Corporate Director |
Jan 27, 2020 | |
| Kiandre Brasher |
Corporate Officer |
Feb 27, 2017 | |
| Corporate Director |
Feb 27, 2017 | ||
| Daniel I Stusser |
Corporate Officer |
Jan 27, 2020 | |
| Corporate Director |
Jan 27, 2020 | ||
| Robert Rust |
Corporate Director |
Mar 22, 2021 | |
| Rachel C Wood |
Corporate Officer |
Apr 27, 2020 | |
| Corporate Director |
Apr 27, 2020 | ||
| Greg S Martin |
Corporate Officer |
Jan 1, 2019 | |
| Corporate Director |
Nov 3, 2014 | ||
| Toni R Gwin |
Corporate Director |
Feb 25, 2013 | |
| Gaelon B Spradley |
Corporate Officer |
Apr 28, 2019 | 100% |
| W-2 Managing Employee |
Apr 28, 2019 | 100% | |
| Operational/Managerial Control |
Apr 28, 2019 | 100% | |
| Holly K Sliva |
Corporate Officer |
Sep 23, 2013 | |
| W-2 Managing Employee |
Sep 23, 2013 |
All facility ownership & control disclosures 9
| Facility | Type | Role | Since |
|---|---|---|---|
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Nov 24, 2013 |
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jul 26, 2010 |
| Lewis County Community Health Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | May 8, 2006 |
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Apr 3, 2012 |
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 12, 2013 |
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Apr 2, 2014 |
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jun 1, 2017 |
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2023 |
| Valley View Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Nov 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20060425000389 | WA | Part a Provider - Federally Qualified Health Center (FQHC) | 6002803749 | Practice locations: Winlock, WA |
National Provider Directory
- Tax ID family
- Lewis County Community Heal
- Part of
- Lewis County Community Heal
Locations
100 Cedar Crest Dr
Winlock, WA 98596
Phone (360) 785-0300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
100 Cedar Crest Dr
Winlock, WA 98596-9791
Mailing address
2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9565
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G8801670 | Other | WA | MEDICARE GROUP |
Other names
- Valley View Health Center - Winlock
Other providers in Winlock, WA
- Faith Fischer-Whaley
- Go Taxi, Inc.
- Yolanda M Hughes
- Karyn Mai, DDS, PLLC
- Norman Bear Letempt
- Lewis County Fire Protection District Number 15
- Linden House
- Diane Elizabeth Marines
- Marlee Meyers
- Myocare LLC
All providers in Winlock, WA · Federally Qualified Health Center (FQHC) in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.