MEDICARE: COUNTY OF HARNEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	16-1023	OR
2	251E00000X	Home Health Agency	131301	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50074	OTHER		COIHS

General Provider Information

NPI Number	:	1770562670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF HARNEY

Provider Business Mailing Address
First Line	:	415 N FAIRVIEW AVE
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-1417
Country	:	US
Telephone Number	:	541-573-8360
Fax Number	:	541-573-8389

Provider Business Practice Location Address
First Line	:	415 N FAIRVIEW AVE
Second Line	:
City	:	BURNS
State	:	OR
Zip	:	97720-1417
Country	:	US
Telephone Number	:	541-573-8360
Fax Number	:	541-573-8389

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. JODI MCLEAN
Credential	:	RN
Telephone Number	:	541-573-8360

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	05/22/2017

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Directions to “COUNTY OF HARNEY ” Practice Location

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