| NPI | 1962876748 |
|---|---|
| Doing Business As | FAMILY HEALTH CENTER 14TH AVE |
| Entity Type | Organization |
| Authorized Contact | JAMES K COFFEE CEO 360-636-3892 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WA 600176084) |
| Additional Taxonomies | 261QF0050X Clinic/Center, Family Planning, Non-Surgical (Licence: WA 600176084) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: WA 600176084) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WA 600176084) | |
| 261QP2300X Clinic/Center, Primary Care (Licence: WA 600176084) | |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2022-05-31 |