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General NPI Number Information
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NPI Number | 1407017288
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Entity Type | Organization
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Legal Business Name | THE CHILD CENTER
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 3995 MARCOLA RD
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City | SPRINGFIELD
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State | OR
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Zip | 97477-7948
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Country | US
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Telephone | 541-726-1465
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Fax |
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Provider Business Mailing Address
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Address Line | 3995 MARCOLA RD
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City | SPRINGFIELD
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State | OR
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Zip | 97477-7948
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Country | US
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Telephone | 541-726-1465
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Fax |
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Authorized Official
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Title or Position | OUTPATIENT PROGRAM DIRECTOR
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Name | RICK CHAMBERLAIN
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Credential | MA
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Telephone | 541-726-1465
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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 | 9670273
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License Number State | OR
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