Healthcare Provider Details

I. General information

NPI: 1356848352
Provider Name (Legal Business Name): OMHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 SW BLUFF DR STE A
BEND OR
97702-1283
US

IV. Provider business mailing address

PO BOX 70673
SPRINGFIELD OR
97475-0133
US

V. Phone/Fax

Practice location:
  • Phone: 541-508-4858
  • Fax:
Mailing address:
  • Phone: 541-285-3108
  • Fax: 541-780-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELSY CEJA RUIZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-505-8773