Healthcare Provider Details

I. General information

NPI: 1427441849
Provider Name (Legal Business Name): LEWIS COUNTY COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WASHINGTON WAY
CENTRALIA WA
98531-9325
US

IV. Provider business mailing address

2690 NE KRESKY AVE
CHEHALIS WA
98532-2412
US

V. Phone/Fax

Practice location:
  • Phone: 360-388-3259
  • Fax: 360-807-4933
Mailing address:
  • Phone: 360-330-9595
  • Fax: 360-330-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: STEVEN C CLARK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-330-9595