Healthcare Provider Details

I. General information

NPI: 1063744480
Provider Name (Legal Business Name): THERESA ANN HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA ANN YATES

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 SE FOWLER ST STE 2
ROSEBURG OR
97470-3309
US

IV. Provider business mailing address

7200 SKYWAY
PARADISE CA
95969-3280
US

V. Phone/Fax

Practice location:
  • Phone: 541-464-6455
  • Fax:
Mailing address:
  • Phone: 530-877-1965
  • Fax: 530-872-7784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: