Provider Demographics
NPI:1831347087
Name:COMPLEMENTARY INTEGRATED HEALTH CARE,LLC
Entity type:Organization
Organization Name:COMPLEMENTARY INTEGRATED HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALLEN-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-758-9003
Mailing Address - Street 1:619 DIAGONAL ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2041
Mailing Address - Country:US
Mailing Address - Phone:509-758-9003
Mailing Address - Fax:509-758-9001
Practice Address - Street 1:619 DIAGONAL ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2041
Practice Address - Country:US
Practice Address - Phone:509-758-9003
Practice Address - Fax:509-758-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care