Provider Demographics
NPI:1568195097
Name:SMART MOVES INTEGRATED HEALTH SYSTEMS
Entity Type:Organization
Organization Name:SMART MOVES INTEGRATED HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-355-0322
Mailing Address - Street 1:PO BOX E
Mailing Address - Street 2:
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624-0170
Mailing Address - Country:US
Mailing Address - Phone:253-297-5570
Mailing Address - Fax:
Practice Address - Street 1:117 SPRUCE ST E
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624-9174
Practice Address - Country:US
Practice Address - Phone:253-297-5570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health