Organization
COWLITZ FAMILY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES K COFFEE (CEO)
(360) 353-5803
Entity
Organization
Contact information
Practice address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 636-3892
(360) 414-1342
Mailing address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 636-3892
(360) 414-1114
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
WA
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
WA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
WA
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437359551
—
WA
05
—
5033980
—
WA
05
—
7086523
—
WA
05
—
7407349
—
WA
05
—
7900426
—
WA
Enumeration date
07/03/2006
Last updated
05/24/2024
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