| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1710 Allen St, Kelso, Washington |
| Authorized Official Name and Position | Rogelio Riojas (CEO) |
| Authorized Official Contact | 2067635277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: () - | 1710 Allen St Kelso WA 98626-4907 Ph: (360) 261-7020 |
| NPI Number | 1881053353 |
|---|---|
| Provider Enumeration Date | 02/12/2016 |
| Last Update Date | 01/31/2025 |
| Certification Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881053353 | NPI | - | NPPES |
| 2054154 | Medicaid | WA |
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