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General NPI Number Information
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NPI Number | 1043861743
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Entity Type | Organization
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Legal Business Name | GREAT RIVERS BEHAVIORAL HEALTH ADMINISTRATIVE SERVICES ORG
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1723 KRESKY AVE
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City | CENTRALIA
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State | WA
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Zip | 98531
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Country | US
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Telephone | 800-215-4460
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Fax | 855-936-1291
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Provider Business Mailing Address
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Address Line | PO BOX 210
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City | CHEHALIS
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State | WA
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Zip | 98532-0210
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Country | US
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Telephone | 800-215-4460
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Fax | 855-936-1291
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Authorized Official
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Title or Position | CHIEF EXECUTIVE DIRECTOR
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Name | MR. TRINIDAD I MEDINA
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Credential |
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Telephone | 253-336-3237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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