Healthcare Provider Details

I. General information

NPI: 1629270780
Provider Name (Legal Business Name): HOMESTEAD YOUTH & FAMILY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 SE 15TH ST.
PENDLETON OR
97801
US

IV. Provider business mailing address

PO BOX 1325
PENDLETON OR
97801-0260
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-5433
  • Fax: 541-276-8605
Mailing address:
  • Phone: 541-276-5433
  • Fax: 541-276-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number12718785
License Number StateOR

VIII. Authorized Official

Name: CANDICE D. CREGER
Title or Position: CLERICAL SPECIALIST
Credential:
Phone: 541-276-5433