Healthcare Provider Details

I. General information

NPI: 1750402913
Provider Name (Legal Business Name): DOUGLAS COUNTY CHILDRENS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 NE DIAMOND LAKE BLVD
ROSEBURG OR
97470-3573
US

IV. Provider business mailing address

1939 NE DIAMOND LAKE BLVD
ROSEBURG OR
97470-3573
US

V. Phone/Fax

Practice location:
  • Phone: 541-957-5646
  • Fax: 541-957-0191
Mailing address:
  • Phone: 541-957-5646
  • Fax: 541-957-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number00819782-7
License Number StateOR

VIII. Authorized Official

Name: RHONDA FOSTER
Title or Position: BILLING/CREDENTIALING DEPT
Credential:
Phone: 541-957-5646