Healthcare Provider Details

I. General information

NPI: 1255016804
Provider Name (Legal Business Name): OREGON OUTREACH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 PEARL ST STE 101
EUGENE OR
97401-3570
US

IV. Provider business mailing address

1255 PEARL ST STE 101
EUGENE OR
97401-3570
US

V. Phone/Fax

Practice location:
  • Phone: 541-915-6614
  • Fax:
Mailing address:
  • Phone: 541-915-6614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
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: LISA SALDANA
Title or Position: CLINIC DIRECTOR
Credential: PHD
Phone: 541-915-6614