Healthcare Provider Details

I. General information

NPI: 1023322690
Provider Name (Legal Business Name): THE NORTHSTAR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 NW WALL ST
BEND OR
97701-1965
US

IV. Provider business mailing address

1195 NW WALL ST
BEND OR
97701-1965
US

V. Phone/Fax

Practice location:
  • Phone: 541-385-8657
  • Fax: 541-385-0997
Mailing address:
  • Phone: 541-385-8657
  • Fax: 541-385-0997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN GERMAIN FIEVET
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-385-8657