Provider Demographics
NPI:1598764920
Name:COMMUNITY HEALTH OF CENTRAL WASHINGTON
Entity Type:Organization
Organization Name:COMMUNITY HEALTH OF CENTRAL WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-494-6700
Mailing Address - Street 1:501 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3550
Mailing Address - Country:US
Mailing Address - Phone:509-494-6700
Mailing Address - Fax:509-573-6275
Practice Address - Street 1:501 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3550
Practice Address - Country:US
Practice Address - Phone:509-494-6700
Practice Address - Fax:509-573-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602254033207Q00000X
251B00000X, 251S00000X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA25344OtherGROUP HEALTH
WA8932819OtherCRIME VICTIM NUMBER
WADA3135OtherRAILROAD MEDICARE NUMBER
WA7118276Medicaid
WACE0030OtherREGENCE
WA0031820OtherLABOR & INDUSTRIES
WAAB38059Medicare ID - Type UnspecifiedMC PROVIDER #
WA8932819OtherCRIME VICTIM NUMBER