Healthcare Provider Details

I. General information

NPI: 1740324953
Provider Name (Legal Business Name): EASTERN OREGON ALCOHOLISM FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SW HAILEY AVENUE
PENDLETON OR
97801
US

IV. Provider business mailing address

216 S.W. HAILEY AVENUE
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-3518
  • Fax: 541-276-4189
Mailing address:
  • Phone: 541-276-3518
  • Fax: 541-276-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateOR

VIII. Authorized Official

Name: MR. COLIN PETER DUMONT
Title or Position: EXECUTIVE DIRECTOR
Credential: CADCII, QMHP
Phone: 541-276-3518