| Organization Name: | COWLITZ FAMILY HEALTH CENTER |
| NPI Number: | 1104243534 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIAN J COOPER (CEO) |
| Mailing Address: | 621 Grade St Kelso |
| State: | WA US |
| Postal Code: | 986262606 |
| Phone Number: | 3606363892 |
| Fax Number: | 3602328400 |
| NPI Enumeration Date: | 03/24/2014 |
| NPI Last Update Date: | 04/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | 261953 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |