Healthcare Provider Details

I. General information

NPI: 1629168166
Provider Name (Legal Business Name): ADOLESCENT DAY TREATMENT CENTER INC OF DOUGLAS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 S.W. MAIN
WINSTON OR
97496
US

IV. Provider business mailing address

PO BOX 2259
WINSTON OR
97496-2259
US

V. Phone/Fax

Practice location:
  • Phone: 541-679-6129
  • Fax:
Mailing address:
  • Phone: 541-679-6129
  • Fax: 541-679-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberCERTIFCATE OF APPROV
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberCERTIFICATE APPROVAL
License Number StateOR

VIII. Authorized Official

Name: MS. BONNA M MEYER
Title or Position: INTERIM DIRECTOR
Credential:
Phone: 541-679-6129