Healthcare Provider Details

I. General information

NPI: 1376784355
Provider Name (Legal Business Name): COLUMBIACARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20025 MOSSY MEADOWS AVE
OREGON CITY OR
97045-7136
US

IV. Provider business mailing address

3587 HEATHROW WAY
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-858-8170
  • Fax: 541-858-8167
Mailing address:
  • Phone: 541-858-8170
  • Fax: 541-858-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT C BECKETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 541-858-8170