Healthcare Provider Details

I. General information

NPI: 1295747186
Provider Name (Legal Business Name): OSLC COMMUNITY PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 PEARL ST
EUGENE OR
97401-3541
US

IV. Provider business mailing address

1170 PEARL ST
EUGENE OR
97401-3541
US

V. Phone/Fax

Practice location:
  • Phone: 541-743-4340
  • Fax: 541-743-4369
Mailing address:
  • Phone: 541-743-4340
  • Fax: 541-743-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier288554
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MR. PETER GREG SPRENGELMEYER
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 541-743-4340