Healthcare Provider Details

I. General information

NPI: 1609804392
Provider Name (Legal Business Name): FAMILY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 FIRST AVENUE SOUTH
OKANOGAN WA
98840-9679
US

IV. Provider business mailing address

PO BOX 1340
OKANOGAN WA
98840-1340
US

V. Phone/Fax

Practice location:
  • Phone: 509-422-5700
  • Fax: 509-422-7680
Mailing address:
  • Phone: 509-422-5700
  • Fax: 509-422-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number600625131
License Number StateWA

VIII. Authorized Official

Name: MR. JESUS HERNANDEZ
Title or Position: INTERM CEO
Credential:
Phone: 509-422-7601