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General NPI Number Information
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NPI Number | 1003762196
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Entity Type | Organization
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Legal Business Name | ORTC, LLC
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Dates
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Enumeration Date | 03/10/2026
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Last Update Date | 03/10/2026
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Provider Practice Location Address
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Address Line | 2121 ISAACS AVE
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City | WALLA WALLA
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State | WA
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Zip | 99362-2215
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Country | US
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Telephone | 509-578-1492
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Fax | 509-578-1493
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Provider Business Mailing Address
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Address Line | 2121 ISAACS AVE
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City | WALLA WALLA
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State | WA
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Zip | 99362-2215
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Country | US
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Telephone | 253-263-7057
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Fax | 541-237-0988
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Authorized Official
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Title or Position | CREDENTIALING
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Name | DANA JORGENSEN
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Credential |
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Telephone | 541-322-1794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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