Provider Demographics
NPI:1730756644
Name:MOSES LAKE COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:MOSES LAKE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSCHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-766-8971
Mailing Address - Street 1:605 COOLIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837
Mailing Address - Country:US
Mailing Address - Phone:509-765-0674
Mailing Address - Fax:509-764-0344
Practice Address - Street 1:403 JACKRABBIT ST NE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-2008
Practice Address - Country:US
Practice Address - Phone:509-787-8943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSES LAKE COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1016722Medicaid