Provider Demographics
NPI:1710422407
Name:YAKIMA VALLEY FARM WORKERS CLINIC
Entity Type:Organization
Organization Name:YAKIMA VALLEY FARM WORKERS CLINIC
Other - Org Name:GRANGER FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLIVARES
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:509-865-6175
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:TOPPENISH
Mailing Address - State:WA
Mailing Address - Zip Code:98948-0190
Mailing Address - Country:US
Mailing Address - Phone:509-865-6175
Mailing Address - Fax:
Practice Address - Street 1:115 SUNNYSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:WA
Practice Address - Zip Code:98932
Practice Address - Country:US
Practice Address - Phone:509-865-6175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
261QF0400XOtherTAXONOMY