| Great Rivers Behavioral Health Organization | |
|
57 W Main Street Suite 260 Chehalis WA 98532 | |
| (360) 795-5955 | |
| (360) 740-8099 |
| Full Name | Great Rivers Behavioral Health Organization |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 57 W Main Street, Chehalis, Washington |
| Authorized Official Name and Position | Marc Edmund Bollinger (ADMINISTRATOR) |
| Authorized Official Contact | 3607955955 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Rivers Behavioral Health Organization Po Box 1447 Chehalis WA 98532 Ph: (360) 795-5955 | Great Rivers Behavioral Health Organization 57 W Main Street Suite 260 Chehalis WA 98532 Ph: (360) 795-5955 |
| NPI Number | 1285155366 |
|---|---|
| Provider Enumeration Date | 06/29/2017 |
| Last Update Date | 06/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285155366 | NPI | - | NPPES |
| 200458 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 603564565 (Washington) | Primary |
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