NPIMap

Organization Active NPI

Lewis County Community Health Services

Doing business as Valley View Health Center - Centralia

  • Federally Qualified Health Center (FQHC)
  • Centralia, WA
National Provider Identifier
1811669658
Registry record updated Sep 30, 2021
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 - Centralia
Practice address
1800 Cooks Hill Rd Ste F
Centralia, WA 98531-9162
Phone
(360) 736-3042
Fax
(360) 736-2967
NPI assigned
Sep 30, 2021
Last updated
Sep 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2021

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

Authorized official

Name
Gaelon Spradley
Title
Chief Executive Officer
Phone
(360) 330-9555

Specialties & licenses 1

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

Addresses

Primary practice location

1800 Cooks Hill Rd Ste F
Centralia, WA 98531-9162

Mailing address

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

Other names 1

  • Valley View Health Center - Centralia 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…
O20211104002727 WA Part A Provider - Federally Qualified Health Center (FQHC) 6002803749 Practice locations: Centralia, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811669658. Details of each certification follow.

Federally qualified health center certification: CCN 501003

Legal name
LEWIS COUNTY COMMUNITY HEALTH SERVICES
Doing business as
VALLEY VIEW HEALTH CENTER - CENTRALIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2021
Last certification
Dec 14, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 3, 2004 in WA
Enrollment address
1800 Cooks Hill Rd
Ste F
Centralia, WA 98531-9162

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

Locations

1800 Cooks Hill Rd
Ste G
Centralia, WA 98531
Phone (360) 736-3042

225 State Ave NE
Olympia, WA 98501
Phone (360) 236-7166

225 State Ave NE
Ste 5
Olympia, WA 98501
Phone (360) 236-7166

1810 State Highway 508
Onalaska, WA 98570
Phone (360) 978-6600

615 Cemetery Rd
Winlock, WA 98596
Phone (300) 785-3527

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
Gricelda Sanchez Individual Corporate DirectorBoard Member Dec 15, 2021
Bobby D Burger Individual Corporate DirectorBoard Member Dec 15, 2021
Robert C Mohrbacher Individual Corporate DirectorBoard Member Dec 15, 2021
Kiandre Brasher Individual Corporate OfficerTreasurer Dec 15, 2021
Corporate DirectorBoard Member Dec 15, 2021
Daniel I Stusser Individual Corporate OfficerSecretary Dec 15, 2021
Corporate DirectorBoard Member Dec 15, 2021
Robert Rust Individual Corporate DirectorBoard Member Dec 15, 2021
Rachel C Wood Individual Corporate DirectorBoard Member Dec 15, 2021
Marrianne Schumacher Individual Corporate OfficerVice President Dec 15, 2021
Corporate DirectorBoard Member Dec 15, 2021
Greg S Martin Individual Corporate OfficerPresident Dec 15, 2021
Corporate DirectorBoard Member Dec 15, 2021
Toni R Gwin Individual Corporate DirectorBoard Member Dec 15, 2021
Gaelon B Spradley Individual Corporate OfficerCeo Dec 15, 2021
W-2 Managing EmployeeCeo Dec 15, 2021 100%
Operational/Managerial ControlCeo Dec 15, 2021 100%
Holly K Sliva Individual Corporate OfficerCfo Dec 15, 2021
W-2 Managing EmployeeCfo Dec 15, 2021

All facility ownership & control disclosures 9

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 CenterOlympia, WA, CCN 501019 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
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 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 85

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.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1632960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1811669658",
    "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": "1800 COOKS HILL RD STE F",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319162",
            "telephone_number": "360-736-3042",
            "fax_number": "360-736-2967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS COUNTY COMMUNITY HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-30",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-13",
        "status": "A",
        "authorized_official_last_name": "SPRADLEY",
        "authorized_official_first_name": "GAELON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "360-330-9555"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley View Health Center - Centralia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centralia, WA

Sources for this page

Verify at the official NPI Registry.