Healthcare Provider Details

I. General information

NPI: 1295737336
Provider Name (Legal Business Name): JOSEPHINE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 NW F STREET
GRANTS PASS OR
97526
US

IV. Provider business mailing address

301 NW F STREET
GRANTS PASS OR
97526
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-5404
  • Fax: 541-474-5103
Mailing address:
  • Phone: 541-474-5186
  • Fax: 541-474-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES GOODWIN
Title or Position: DIRECTOR, JUVENILE JUSTICE
Credential:
Phone: 541-474-5186