Provider Demographics
NPI:1346266152
Name:COLUMBIA VALLEY COMMUNITY HEALTH
Entity Type:Organization
Organization Name:COLUMBIA VALLEY COMMUNITY HEALTH
Other - Org Name:CVCH CHELAN BEHAVIORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-664-3528
Mailing Address - Street 1:600 ORONDO AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-6000
Mailing Address - Fax:509-664-4590
Practice Address - Street 1:504 ORONDO AVE STE A
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2830
Practice Address - Country:US
Practice Address - Phone:509-662-1269
Practice Address - Fax:509-664-1037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA VALLEY COMMUNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-14
Last Update Date:2020-11-19
Deactivation Date:2012-06-21
Deactivation Code:
Reactivation Date:2012-07-25
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 261QF0400X
WA234261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2000949Medicaid
WA1981240Medicaid
WA50-1909OtherMEDICARE FQHC