Healthcare Provider Details

I. General information

NPI: 1154533222
Provider Name (Legal Business Name): COMMUNITY HEALTH OF CENTRAL WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 12TH AVE
YAKIMA WA
98902-3115
US

IV. Provider business mailing address

501 S 5TH AVE
YAKIMA WA
98902-3550
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-0114
  • Fax: 509-575-0808
Mailing address:
  • Phone: 509-494-6700
  • Fax: 509-573-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MISS ANGELA GONZALEZ
Title or Position: CEO
Credential:
Phone: 509-494-6700