Provider Demographics
NPI:1295271427
Name:CASCADE HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:CASCADE HEALTH SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-344-8166
Mailing Address - Street 1:500 W FIR ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3201
Mailing Address - Country:US
Mailing Address - Phone:360-504-3601
Mailing Address - Fax:360-504-3602
Practice Address - Street 1:500 W FIR ST
Practice Address - Street 2:SUITE C
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3201
Practice Address - Country:US
Practice Address - Phone:360-504-3601
Practice Address - Fax:360-504-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2045741Medicaid
WAG8938782Medicare PIN