| Fourth Plain Forward | |
|
5107 E 4th Plain Blvd Ste 111 Vancouver WA 98661-8505 | |
| (971) 570-4999 | |
| Not Available |
| Full Name | Fourth Plain Forward |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 5107 E 4th Plain Blvd Ste 111, Vancouver, Washington |
| Authorized Official Name and Position | Wil Fuentes (PROGRAM MANAGER) |
| Authorized Official Contact | 9715704999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fourth Plain Forward 5107 E 4th Plain Blvd Ste 111 Vancouver WA 98661-8505 Ph: (971) 570-4999 | Fourth Plain Forward 5107 E 4th Plain Blvd Ste 111 Vancouver WA 98661-8505 Ph: (971) 570-4999 |
| NPI Number | 1215774229 |
|---|---|
| Provider Enumeration Date | 07/09/2024 |
| Last Update Date | 07/09/2024 |
| Certification Date | 07/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215774229 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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