Healthcare Provider Details

I. General information

NPI: 1063561959
Provider Name (Legal Business Name): COUNTY OF JEFFERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NE A ST STE 102
MADRAS OR
97741-1842
US

IV. Provider business mailing address

500 NE A ST STE 102
MADRAS OR
97741-1842
US

V. Phone/Fax

Practice location:
  • Phone: 541-475-4456
  • Fax: 541-475-0132
Mailing address:
  • Phone: 541-475-4456
  • Fax: 541-475-0132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberCH-0000017
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberCH-0000017
License Number StateOR

VIII. Authorized Official

Name: KATHERINE RUSSELL
Title or Position: DIRECTOR
Credential: MPH
Phone: 541-475-4456