Healthcare Provider Details

I. General information

NPI: 1548172315
Provider Name (Legal Business Name): SKYLINE RECOVERY BEND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 NW COLORADO AVE
BEND OR
97703-3257
US

IV. Provider business mailing address

625 NW COLORADO AVE
BEND OR
97703-3257
US

V. Phone/Fax

Practice location:
  • Phone: 541-205-9126
  • Fax:
Mailing address:
  • Phone: 541-205-9126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY BOSSE
Title or Position: THERAPIST
Credential: LCSW, CADC-I
Phone: 970-729-0652