Provider Demographics
NPI: | 1790050862 |
---|---|
Name: | COMMUNITY HEALTH ASSOCIATION OF SPOKANE |
Entity Type: | Organization |
Organization Name: | COMMUNITY HEALTH ASSOCIATION OF SPOKANE |
Other - Org Name: | SUNSET SCHOOL HEALTH CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AARON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | WILSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 509-444-8888 |
Mailing Address - Street 1: | 611 N IRON BRIDGE WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | SPOKANE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 99202-4932 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-444-8888 |
Mailing Address - Fax: | 509-444-7806 |
Practice Address - Street 1: | 2211 E HARTSON AVE |
Practice Address - Street 2: | |
Practice Address - City: | SPOKANE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 99202-4152 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-444-8888 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-03-21 |
Last Update Date: | 2020-08-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |