Healthcare Provider Details

I. General information

NPI: 1346266152
Provider Name (Legal Business Name): COLUMBIA VALLEY COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date: 06/21/2012
Reactivation Date: 07/25/2012

III. Provider practice location address

504 ORONDO AVE STE A
WENATCHEE WA
98801-2830
US

IV. Provider business mailing address

600 ORONDO AVE STE 1
WENATCHEE WA
98801-2800
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-1269
  • Fax: 509-664-1037
Mailing address:
  • Phone: 509-662-6000
  • Fax: 509-664-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number234
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number234
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number234
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID OLSON
Title or Position: CEO
Credential:
Phone: 509-664-3528