Provider Demographics
NPI:1922051978
Name:YAKIMA VALLEY FARM WORKERS CLINIC
Entity Type:Organization
Organization Name:YAKIMA VALLEY FARM WORKERS CLINIC
Other - Org Name:SPOKANE FALLS FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
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:509-326-4343
Mailing Address - Fax:509-326-4289
Practice Address - Street 1:120 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2315
Practice Address - Country:US
Practice Address - Phone:509-326-4343
Practice Address - Fax:509-326-4289
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YAKIMA VALLEY FARM WORKERS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7107915Medicaid
WA30820OtherLABOR AND INDUSTRIES
WA501860Medicare ID - Type UnspecifiedFQHC MEDICARE
WACH8643Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WA7107915Medicaid