Healthcare Provider Details

I. General information

NPI: 1083162333
Provider Name (Legal Business Name): DEBORAH HOPKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 SUNSET DR
ONTARIO OR
97914-3121
US

IV. Provider business mailing address

686 NW 9TH ST
ONTARIO OR
97914-1600
US

V. Phone/Fax

Practice location:
  • Phone: 541-889-9167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: