Provider Demographics
NPI:1841534252
Name:SOUTHWEST WASHINGTON BEHAVIORAL HEALTH REGIONAL SUPPORT NETWORK
Entity type:Organization
Organization Name:SOUTHWEST WASHINGTON BEHAVIORAL HEALTH REGIONAL SUPPORT NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOM-CHHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-397-8222
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98666-0664
Mailing Address - Country:US
Mailing Address - Phone:360-397-8222
Mailing Address - Fax:360-397-6128
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:BLDG. 17, SUITE C214
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:360-397-8222
Practice Address - Fax:360-397-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization