Provider Demographics
NPI:1215993324
Name:YAKIMA VALLEY FARM WORKER CLINIC
Entity type:Organization
Organization Name:YAKIMA VALLEY FARM WORKER CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES MANGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHW
Authorized Official - Phone:509-453-1344
Mailing Address - Street 1:5701 W CHESTNUT AVE
Mailing Address - Street 2:UNIT 20
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3118
Mailing Address - Country:US
Mailing Address - Phone:509-965-5071
Mailing Address - Fax:
Practice Address - Street 1:918 E. MEAD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98903-3118
Practice Address - Country:US
Practice Address - Phone:509-965-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006043302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00006043Medicare UPIN