Healthcare Provider Details

I. General information

NPI: 1740543297
Provider Name (Legal Business Name): MARION COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3529 FISHER RD NE
SALEM OR
97305
US

IV. Provider business mailing address

3180 CENTER ST NE
SALEM OR
97301-4592
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-1399
  • Fax:
Mailing address:
  • Phone: 503-362-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateOR

VIII. Authorized Official

Name: MAI CAO
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 503-361-2648