| NPI | 1972977924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER KREIDLER-MOSS CEO 360-475-6707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 251E00000X Home Health | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2022-05-10 |