=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477860989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OREGON CASCADES WEST COUNCIL OF GOVERNMENTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2010
-----------------------------------------------------
Last Update Date | 09/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 QUEEN AVE SE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97322-6796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-924-8438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 QUEEN AVE SE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97322-6796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-924-8438
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM MANAGER
-----------------------------------------------------
Name | GALE BLASQUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-967-8630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------