Healthcare Provider Details

I. General information

NPI: 1134883887
Provider Name (Legal Business Name): REVEILLE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 TYLER ST
EUGENE OR
97402-4530
US

IV. Provider business mailing address

1711 WILLAMETTE STREET SUITE 301, #779
EUGENE OR
97401-1914
US

V. Phone/Fax

Practice location:
  • Phone: 541-603-0276
  • Fax:
Mailing address:
  • Phone: 602-369-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management 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 Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. STEVEN DOUGLAS YAMAMORI
Title or Position: PRESIDENT/CEO
Credential: MED, QMHA-R
Phone: 602-369-3531