Healthcare Provider Details

I. General information

NPI: 1063935823
Provider Name (Legal Business Name): YAKIM VALLEY FARM WORKERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 S QUILLAN PL STE 110
KENNEWICK WA
99338-1899
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-6175
  • Fax:
Mailing address:
  • Phone: 509-865-6175
  • Fax: 509-865-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number600304660-001-0035
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number600304660-001-0035
License Number StateWA

VIII. Authorized Official

Name: CHRISTINE TROTTER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 509-865-6175