Healthcare Provider Details

I. General information

NPI: 1710462304
Provider Name (Legal Business Name): YAKIMA VALLEY FARM WORKERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 SE BISHOP BLVD
PULLMAN WA
99163-5452
US

IV. Provider business mailing address

PO BOX 190
TOPPENISH WA
98948-0190
US

V. Phone/Fax

Practice location:
  • Phone: 509-715-1700
  • Fax: 509-715-1030
Mailing address:
  • Phone: 509-865-6175
  • Fax: 509-865-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE TROTTER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 508-865-6175