Healthcare Provider Details

I. General information

NPI: 1376690107
Provider Name (Legal Business Name): SHELTERCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 W 4TH AVE
EUGENE OR
97401-2505
US

IV. Provider business mailing address

499 W 4TH AVE
EUGENE OR
97401-2505
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-1262
  • Fax: 541-686-0359
Mailing address:
  • Phone: 541-686-1262
  • Fax: 541-686-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN ETTER
Title or Position: CONTROLLER
Credential:
Phone: 541-686-1262