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General NPI Number Information
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NPI Number | 1164111472
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Entity Type | Organization
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Legal Business Name | OREGON RECOVERY BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 147 SW COURT ST
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City | DALLAS
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State | OR
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Zip | 97338-3112
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Country | US
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Telephone | 503-304-4358
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20674
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City | KEIZER
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State | OR
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Zip | 97307-0674
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Country | US
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Telephone | 503-304-4358
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JUSTIN SCOTT NIELSEN
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Credential | CADC II
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Telephone | 503-304-4358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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