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General NPI Number Information
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NPI Number | 1538320528
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Entity Type | Organization
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Legal Business Name | COOS COUNTY CORRECTIONAL TREATMENT CENTER
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 1975 MCPHERSON ST
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City | NORTH BEND
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State | OR
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Zip | 97459-3482
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Country | US
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Telephone | 541-756-2020
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Fax | 541-756-4401
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Provider Business Mailing Address
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Address Line | PO BOX 849
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City | NORTH BEND
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State | OR
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Zip | 97459-0070
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Country | US
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Telephone | 541-756-2020
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Fax | 541-756-4401
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | KELLY CHURCH
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Credential |
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Telephone | 541-396-3173
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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 | OR
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