Healthcare Provider Details

I. General information

NPI: 1295271427
Provider Name (Legal Business Name): CASCADE HEALTH SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FIR ST SUITE C
SEQUIM WA
98382-3201
US

IV. Provider business mailing address

500 W FIR ST SUITE C
SEQUIM WA
98382-3201
US

V. Phone/Fax

Practice location:
  • Phone: 360-504-3601
  • Fax: 360-504-3602
Mailing address:
  • Phone: 360-504-3601
  • Fax: 360-504-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2045741
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: DEBBIE FOUNTAIN
Title or Position: CLINIC OPERATIONS MANAGER
Credential:
Phone: 360-344-8166