Healthcare Provider Details

I. General information

NPI: 1952977480
Provider Name (Legal Business Name): DENOVO CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 COUNTRY CLUB RD STE A140
EUGENE OR
97401-6028
US

IV. Provider business mailing address

1863 PIONEER PKWY E # 203
SPRINGFIELD OR
97477-3907
US

V. Phone/Fax

Practice location:
  • Phone: 541-556-6552
  • Fax: 541-230-9656
Mailing address:
  • Phone: 541-556-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
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: STEPHANIE WAGUESPACK
Title or Position: CHIEF OPERATING OFFICER/FOUNDER
Credential:
Phone: 541-556-5652