Healthcare Provider Details

I. General information

NPI: 1275365702
Provider Name (Legal Business Name): STABILITY SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 26TH ST
WHITE CITY OR
97503-1350
US

IV. Provider business mailing address

8111 26TH ST
WHITE CITY OR
97503-1350
US

V. Phone/Fax

Practice location:
  • Phone: 541-944-0262
  • Fax:
Mailing address:
  • Phone: 541-944-0262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRIS EGELSTON
Title or Position: OWNER
Credential: MBA, CADC, QMHA, THW
Phone: 541-944-0262