Healthcare Provider Details

I. General information

NPI: 1154106987
Provider Name (Legal Business Name): HOMES FOR GOOD HOUSING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-2769
US

IV. Provider business mailing address

100 W 13TH AVE
EUGENE OR
97401-3433
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3999
  • Fax:
Mailing address:
  • Phone: 541-682-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JACOB FOX
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-682-2527