=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043024714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HEALTH OF CENTRAL WASHINGTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2025
-----------------------------------------------------
Last Update Date | 02/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 E MOUNTAIN VIEW AVE
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-3865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-494-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 S 5TH AVE
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98902-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-494-6700
-----------------------------------------------------
Fax | 509-573-6275
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | ANGELA GONZALEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-494-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------