Healthcare Provider Details

I. General information

NPI: 1043249907
Provider Name (Legal Business Name): WALLOWA VALLEY CENTER FOR WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 MEDICAL PKWY
ENTERPRISE OR
97828-5140
US

IV. Provider business mailing address

PO BOX 268
ENTERPRISE OR
97828-0268
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-4524
  • Fax: 541-426-3035
Mailing address:
  • Phone: 541-426-4524
  • Fax: 541-426-3035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JIM NAVE
Title or Position: BOARD CHAIR
Credential:
Phone: 541-426-4524