Healthcare Provider Details

I. General information

NPI: 1346057072
Provider Name (Legal Business Name): CREATING HOUSING COALITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 WAVERLY DR SE
ALBANY OR
97321-4503
US

IV. Provider business mailing address

PO BOX 892
ALBANY OR
97321-0329
US

V. Phone/Fax

Practice location:
  • Phone: 541-704-7280
  • Fax:
Mailing address:
  • Phone: 541-704-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: CAROL DAVIES
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 541-704-7280