Provider Demographics
NPI:1588390835
Name:CHAY ENVIRONMENAL
Entity type:Organization
Organization Name:CHAY ENVIRONMENAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-410-6557
Mailing Address - Street 1:22721 MAYGER HEIGHTS LN
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-2404
Mailing Address - Country:US
Mailing Address - Phone:503-410-6557
Mailing Address - Fax:
Practice Address - Street 1:111 PACIFIC AVE N
Practice Address - Street 2:
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-3446
Practice Address - Country:US
Practice Address - Phone:360-998-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAY ENVIRONMENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-28
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health