Healthcare Provider Details

I. General information

NPI: 1629127584
Provider Name (Legal Business Name): UMATILLA COUNTY ALCOHOL & DRUG PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HAILEY AVE SUITE 203
PENDLETON OR
97801-3073
US

IV. Provider business mailing address

200 SE HAILEY AVE SUITE 203
PENDLETON OR
97801-3073
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-6330
  • Fax: 541-278-5419
Mailing address:
  • Phone: 541-278-6330
  • Fax: 541-278-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOR

VIII. Authorized Official

Name: MS. CR MASON
Title or Position: PROGRAM ADMINISTRATION
Credential: CADC
Phone: 541-278-6330