Organization
FOURTH PLAIN FORWARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WIL FUENTES (PROGRAM MANAGER)
(971) 570-4999
Entity
Organization
Contact information
Practice address
5107 E 4TH PLAIN BLVD STE 111, VANCOUVER, WA 98661-8505
(971) 570-4999
Mailing address
5107 E 4TH PLAIN BLVD STE 111, VANCOUVER, WA 98661-8505
(971) 570-4999
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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