Healthcare Provider Details

I. General information

NPI: 1972328151
Provider Name (Legal Business Name): BENTON COUNTY HEALTH DEPARTMENT FLEXIBLE HOUSING SUBSIDY POOL PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NW 27TH ST
CORVALLIS OR
97330-5223
US

IV. Provider business mailing address

PO BOX 579
CORVALLIS OR
97339-0579
US

V. Phone/Fax

Practice location:
  • Phone: 541-766-6835
  • Fax: 541-766-6186
Mailing address:
  • Phone: 541-766-6835
  • Fax: 541-766-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: LACEY MOLLEL
Title or Position: HEALTH DEPARTMENT DIRECTOR
Credential:
Phone: 541-766-6835