Healthcare Provider Details

I. General information

NPI: 1891935235
Provider Name (Legal Business Name): COOS COUNTY OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 MCPHERSON ST SUITE 2
NORTH BEND OR
97459-3482
US

IV. Provider business mailing address

1975 MCPHERSON ST SUITE 2
NORTH BEND OR
97459-3482
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-2020
  • Fax: 541-756-8982
Mailing address:
  • Phone: 541-756-2020
  • Fax: 541-756-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GINGER SWAN
Title or Position: DIRECTOR
Credential:
Phone: 541-756-2020