Provider Demographics
NPI:1669918876
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 1:32 KALA SQUARE PL
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9804
Mailing Address - Country:US
Mailing Address - Phone:360-344-8166
Mailing Address - Fax:360-379-6518
Practice Address - Street 1:32 KALA SQUARE PL
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9804
Practice Address - Country:US
Practice Address - Phone:360-344-8166
Practice Address - Fax:360-379-6518
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