Healthcare Provider Details

I. General information

NPI: 1972726867
Provider Name (Legal Business Name): COWLITZ FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 S SILVER LAKE RD
CASTLE ROCK WA
98611-8021
US

IV. Provider business mailing address

1057 12TH AVE
LONGVIEW WA
98632-2509
US

V. Phone/Fax

Practice location:
  • Phone: 360-274-3262
  • Fax: 360-274-3345
Mailing address:
  • Phone: 360-636-3892
  • Fax: 360-232-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateWA

VIII. Authorized Official

Name: JAMES K COFFEE
Title or Position: CEO
Credential: CEO
Phone: 360-636-3892