Healthcare Provider Details

I. General information

NPI: 1386953891
Provider Name (Legal Business Name): SNOW PEAK YOUTH CAMP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44644 CAMP MORRISON DR BOX 482
SCIO OR
97374-9336
US

IV. Provider business mailing address

PO BOX 482
SCIO OR
97374-0482
US

V. Phone/Fax

Practice location:
  • Phone: 503-394-4294
  • Fax: 503-394-7096
Mailing address:
  • Phone: 503-394-4294
  • Fax: 503-394-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0231
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JENIVEVE ROLLINS
Title or Position: CLINICAL DIRECTOR, BOARD CHAIR
Credential: LCSW
Phone: 503-394-4294