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General NPI Number Information
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NPI Number | 1003362922
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Entity Type | Organization
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Legal Business Name | MID-VALLEY HEALTHCARE, INC.
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 100 MULLINS DR STE C1
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City | LEBANON
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State | OR
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Zip | 97355-2868
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Country | US
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Telephone | 541-451-7450
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MULLINS DR STE C1
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City | LEBANON
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State | OR
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Zip | 97355-2868
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Country | US
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Telephone | 541-451-7450
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Fax |
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Authorized Official
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Title or Position | CEO-SLCH
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Name | DANIEL RACKHAM
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Credential |
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Telephone | 541-768-6768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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