Healthcare Provider Details

I. General information

NPI: 1043059454
Provider Name (Legal Business Name): EASTERN OREGON HEALTH & WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 6TH ST
LA GRANDE OR
97850-2419
US

IV. Provider business mailing address

PO BOX 975
LA GRANDE OR
97850-0975
US

V. Phone/Fax

Practice location:
  • Phone: 541-805-2626
  • Fax: 541-624-6005
Mailing address:
  • Phone: 541-805-2626
  • Fax: 541-605-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE YVONNE FRIZZELL
Title or Position: DIRECTOR
Credential: CADCII, CRM
Phone: 541-910-5577