Healthcare Provider Details

I. General information

NPI: 1356971493
Provider Name (Legal Business Name): OREGON WASHINGTON HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SW DORION AVE
PENDLETON OR
97801-2070
US

IV. Provider business mailing address

PO BOX 882
PENDLETON OR
97801-0882
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-8844
  • Fax:
Mailing address:
  • Phone: 541-429-8844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA CARNES
Title or Position: BILLING MANAGER
Credential:
Phone: 541-429-8049