Healthcare Provider Details

I. General information

NPI: 1528628898
Provider Name (Legal Business Name): EUGENIA CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N MARKET BLVD
CHEHALIS WA
98532-2677
US

IV. Provider business mailing address

PO BOX 1371
CHEHALIS WA
98532-0340
US

V. Phone/Fax

Practice location:
  • Phone: 360-948-0203
  • Fax:
Mailing address:
  • Phone: 360-948-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FABIOLA GONZALEZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-266-5585