Healthcare Provider Details

I. General information

NPI: 1477974293
Provider Name (Legal Business Name): COLUMBIACARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 WESTGATE BLDG E
PENDLETON OR
97801-9613
US

IV. Provider business mailing address

3587 HEATHROW WAY
MEDFORD OR
97504-4004
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number86761393
License Number StateOR

VIII. Authorized Official

Name: MICHAEL DAVID SEWITSKY
Title or Position: FINANCE MANAGER
Credential:
Phone: 541-858-8170