Healthcare Provider Details

I. General information

NPI: 1376858092
Provider Name (Legal Business Name): NORTHEAST OREGON COMMUNITY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 I AVE
LA GRANDE OR
97850-2043
US

IV. Provider business mailing address

1101 I AVE
LA GRANDE OR
97850-2043
US

V. Phone/Fax

Practice location:
  • Phone: 541-962-0162
  • Fax: 541-962-0119
Mailing address:
  • Phone: 541-962-0162
  • Fax: 541-962-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY A GOLDSTEIN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 541-962-0162