Provider Demographics
NPI:1326729864
Name:LEWIS COUNTY COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:LEWIS COUNTY COMMUNITY HEALTH SERVICES
Other - Org Name:VALLEY VIEW HEALTH CENTER MARY'S CORNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GAELON
Authorized Official - Middle Name:B
Authorized Official - Last Name:SPRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-330-9555
Mailing Address - Street 1:2690 NE KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2412
Mailing Address - Country:US
Mailing Address - Phone:360-330-9595
Mailing Address - Fax:360-330-9560
Practice Address - Street 1:4254 JACKSON HWY
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8424
Practice Address - Country:US
Practice Address - Phone:360-996-6603
Practice Address - Fax:360-996-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7126972Medicaid