NPIMap

Organization Active NPI

Cowlitz Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Longview, WA
National Provider Identifier
1891724506
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COWLITZ FAMILY HEALTH CENTER
Practice address
1057 12TH Ave
Longview, WA 98632-2509
Phone
(360) 636-3892
Fax
(360) 414-1342
NPI assigned
Jul 3, 2006
Last updated
May 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Authorized official

Name
James K Coffee
Title
Ceo
Phone
(360) 353-5803

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X WA
Non-Surgical Family Planning Clinic/Center 261QF0050X WA
Federally Qualified Health Center (FQHC) 261QF0400X WA Primary
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Primary Care Clinic/Center 261QP2300X NU

Addresses

Primary practice location

1057 12TH Ave
Longview, WA 98632-2509

Mailing address

1057 12TH Ave
Longview, WA 98632-2509
Phone (360) 636-3892

Other identifiers 5

IdentifierTypeStateIssuer
7407349MedicaidWA
7086523MedicaidWA
7900426MedicaidWA
1437359551MedicaidWA
5033980MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, WI4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040324000330 WA Part B Supplier - Clinic/Group Practice 5991696395 Receives reassigned benefits from 19 practitioners
7 other NPIs on this enrollment
Practice locations: Castle Rock, WA; Cathlamet, WA; Kelso, WA; Longview, WA; Ocean Park, WA; Woodland, WA
O20040825000373 WA Part A Provider - Federally Qualified Health Center (FQHC) 5991696395 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Woodland, WA
O20040825000841 WA Part A Provider - Federally Qualified Health Center (FQHC) 5991696395 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ocean Park, WA
O20101110001186 WI Part A Provider - Federally Qualified Health Center (FQHC) 5991696395 Practice locations: Longview, WA

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1891724506. Details of each certification follow.

Federally qualified health center certification: CCN 501884

Legal name
COWLITZ FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2004
Last certification
Oct 1, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1973 in WA
Enrollment address
1251 Lewis River Rd D
Woodland, WA 98674-9203
Related CCNs
501852

Federally qualified health center certification: CCN 501885

Legal name
COWLITZ FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2004
Last certification
Oct 1, 2004
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Feb 28, 1973 in WA
Enrollment address
21610 Pacific Way
Ocean Park, WA 98640-3206
Related CCNs
501852

Federally qualified health center certification: CCN 501852

Legal name
COWLITZ FAMILY HEALTH CENTER
Doing business as
FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 30, 1999
Last certification
Sep 30, 1999
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1973 in WA
Enrollment address
1057 12TH Ave
Longview, WA 98632-2509

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

300 Oak St
#B
Kelso, WA 98626
Phone (360) 353-5511

831 12th Ave
Longview, WA 98632
Phone (360) 575-9155

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
Wanda M McBee Individual Corporate OfficerBoard Secretary Aug 1, 2006
Corporate OfficerBoard Secretary Jun 1, 1994
Deborah Idlett Nelson Individual Corporate DirectorBoard Member Aug 4, 2020
Ryleigh Leatherwood Individual Corporate DirectorBoard Member Feb 2, 2022
James Coffee Individual W-2 Managing EmployeeCeo Dec 1, 2020 100%
Operational/Managerial ControlCeo Dec 1, 2020 100%
W-2 Managing EmployeeCeo Apr 1, 2021 100%
Corporate OfficerCeo Dec 1, 2020 100%
Leah McElyea Individual Corporate DirectorBoard Member Dec 1, 2021
Cynthia L Washington-Mattson Individual Corporate OfficerBoard Vice President Jun 1, 1994
Quincey Shinnick Individual Corporate DirectorBoard Member Mar 24, 2020
Mark Nelson Individual Corporate OfficerBoard President Dec 4, 2019
Okal Denise Oldroyd Individual Corporate DirectorBoard Member Dec 1, 2021
Mark Gaither Individual Corporate DirectorBoard Member May 2, 2018

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1891724506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-636-3892",
            "fax_number": "360-414-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 12TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322509",
            "telephone_number": "360-636-3892",
            "fax_number": "360-414-1342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COWLITZ FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2024-05-24",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "COFFEE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "360-353-5803"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7407349",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7086523",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7900426",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437359551",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5033980",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

Verify at the official NPI Registry.