Organization
COWLITZ INDIAN TRIBE
Active
Parent organization
COWLITZ INDIAN TRIBE
Other names
Cowlitz Tribal Treatment
Organization subpart
Yes
Provider details
NPI number
Legal business name
COWLITZ INDIAN TRIBE
Authorized official
SHAVON KELLER (BILLING SUPERVISOR)
(360) 353-9431
Entity
Organization
Contact information
Practice address
7700 NE 26TH AVE, VANCOUVER, WA 98665-0672
(360) 397-8228
(360) 575-1950
Mailing address
P.O. BOX 2429, LONGVIEW, WA 98632
(360) 397-8228
(360) 575-1950
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2007
Last updated
07/22/2024
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