Healthcare Provider Details

I. General information

NPI: 1871245183
Provider Name (Legal Business Name): LGS OPERATING COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 COBURG RD STE C
EUGENE OR
97401-6114
US

IV. Provider business mailing address

87750 CHARLET DR
EUGENE OR
97402-9151
US

V. Phone/Fax

Practice location:
  • Phone: 541-505-9190
  • Fax:
Mailing address:
  • Phone: 541-525-3139
  • 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 TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
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: ASHLEY TEETERS
Title or Position: CEO
Credential:
Phone: 541-525-3139