NPIMap

Organization Active NPI

Community Integrated Health Services, LLC

  • Community/Behavioral Health Agency
  • Centralia, WA
National Provider Identifier
1942840160
Registry record updated Sep 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COMMUNITY INTEGRATED HEALTH SERVICES, LLC
Practice address
1707 Cooks Hill Rd
Centralia, WA 98531-9071
Phone
(360) 261-6930
NPI assigned
Jan 15, 2020
Last updated
Sep 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GREAT RIVERS BEHAVIORAL HEALTH ORGANIZATION, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 27, 2022

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

Authorized official

Name
Mr. Marc Edmund Bollinger, LICSWNPI 1932267283
Title
Executive Director
Phone
(360) 795-5955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X
Peer SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 175T00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1707 Cooks Hill Rd
Centralia, WA 98531-9071

Mailing address

PO Box 1447
Chehalis, WA 98532-0378

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220917000568 WA Part B Supplier - Clinic/Group Practice 8123403797 Receives reassigned benefits from 2 practitioners
Practice locations: Aberdeen, WA; Raymond, WA; Longview, WA; Ilwaco, WA; Centralia, WA

National Provider Directory

National Provider Directory
Part of
Great Rivers Behavioral Health Organization

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

  • County of Pacific

    dba Pacific County Public Health and Human Service Department

    • Public Health or Welfare Agency
    • South Bend, WA
    • NPI 1508081217

    Member Of

    NPD member
  • Wahkiakum County

    dba Wahkiakum County Health & Human Services

    • Public Health or Welfare Agency
    • Cathlamet, WA
    • NPI 1275692147

    Member Of

    NPD member

Locations

110 W Market St
Ste 204
Aberdeen, WA 98520

1812 Sumner Ave
Aberdeen, WA 98520
Phone (360) 532-0060

614 W Market St
Aberdeen, WA 98520
Phone (360) 584-5143

618 W Market St
Aberdeen, WA 98520
Phone (360) 219-3933

1616 S Gold St
Centralia, WA 98531
Phone (360) 623-9419

1639 Kresky Ave
Centralia, WA 98531
Phone (360) 807-4711

1707 Cooks Hill Rd
Centralia, WA 98531
Phone (360) 736-1965

1116 14th Ave
Longview, WA 98632
Phone (360) 623-5784

1128 Broadway St
Longview, WA 98632
Phone (360) 669-9199

1338 Commerce Ave
Ste 303
Longview, WA 98632
Phone (360) 414-2236

335 3rd St
Raymond, WA 98577
Phone (360) 580-0717

Practitioners & affiliated clinicians

Practitioners 89

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 89

NPI Registry JSON

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

{
    "created_epoch": "1579046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1942840160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1447",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985320378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 COOKS HILL RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319071",
            "telephone_number": "360-261-6930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY INTEGRATED HEALTH SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREAT RIVERS BEHAVIORAL HEALTH ORGANIZATION, LLC",
        "enumeration_date": "2020-01-15",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "BOLLINGER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "EDMUND",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "360-795-5955",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centralia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.