OrganizationActive
Cowlitz Indian Tribe
NPI 1538412630 · Substance Use Disorder Rehabilitation Clinic/Center · Vancouver, WA
Provider details
- NPI number
- 1538412630
- Entity type
- Organization
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- Northstar Clinic
- Organization subpart
- Yes
- Authorized official
- Shavon Keller, Billing Supervisor(360) 353-9431
Specialties & taxonomies
Ambulatory Health Care Facilities
- Methadone Clinic261QM2800X
Ambulatory Health Care Facilities
Ambulatory Health Care Facilities
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
7105 Ne 40th St
Vancouver, WA 98661-3058
Phone: (360) 353-9431
Fax: (360) 353-9440
Street-level locationGet directions
Mailing address
Po Box 2429
Longview, WA 98632-8486
Other names (DBA / former)
- Doing business as
- Cowlitz Indian Tribe
- Doing business as
- Northstar Clinic
Registry dates
- Enumerated
- 2012-10-26
- Last updated
- 2025-10-02
- Certified
- 2025-10-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.