Healthcare Provider Details

I. General information

NPI: 1215017751
Provider Name (Legal Business Name): PACIFIC CENTER FOR CHILDREN AND FAMILIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 MARION STREET
NORTH BEND OR
97459
US

IV. Provider business mailing address

PO BOX 987
NORTH BEND OR
97459
US

V. Phone/Fax

Practice location:
  • Phone: 541-756-2516
  • Fax: 541-756-2516
Mailing address:
  • Phone: 541-756-2516
  • Fax: 541-756-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA LEE
Title or Position: CHAIR BOARD OF DIRECTORS
Credential:
Phone: 541-267-1332