Provider Demographics
NPI:1689899296
Name:THE CHEHALIS TRIBAL HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:THE CHEHALIS TRIBAL HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:POCKAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-858-1660
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98568-0570
Mailing Address - Country:US
Mailing Address - Phone:360-858-1660
Mailing Address - Fax:360-858-1750
Practice Address - Street 1:21 NIEDERMAN RD
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:WA
Practice Address - Zip Code:98568
Practice Address - Country:US
Practice Address - Phone:360-858-1660
Practice Address - Fax:360-858-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9059296Medicaid