Healthcare Provider Details

I. General information

NPI: 1295480101
Provider Name (Legal Business Name): COUNTY OF CROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 NW BEAVER ST STE 100
PRINEVILLE OR
97754-1802
US

IV. Provider business mailing address

375 NW BEAVER ST STE 100
PRINEVILLE OR
97754-1802
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-5165
  • Fax:
Mailing address:
  • Phone: 541-447-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: JOANNA MCCABE
Title or Position: CLINICAL SUPERVISOR
Credential:
Phone: 541-815-1738