Provider Demographics
NPI:1871971879
Name:CLATSKANIE SCHOOL BASED HEALTH CENTER
Entity type:Organization
Organization Name:CLATSKANIE SCHOOL BASED HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-325-8315
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-0239
Mailing Address - Country:US
Mailing Address - Phone:503-325-8315
Mailing Address - Fax:503-468-0193
Practice Address - Street 1:471 SW BELAIR DR
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016-7415
Practice Address - Country:US
Practice Address - Phone:503-325-8315
Practice Address - Fax:503-468-0193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)