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General NPI Number Information
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NPI Number | 1568558955
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Entity Type | Organization
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Legal Business Name | LIFEWAYS, INC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 702 SUNSET DR
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City | ONTARIO
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State | OR
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Zip | 97914-3121
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Country | US
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Telephone | 541-889-9167
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Fax | 541-889-7873
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Provider Business Mailing Address
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Address Line | 702 SUNSET DR
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City | ONTARIO
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State | OR
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Zip | 97914-3121
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Country | US
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Telephone | 541-889-9167
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Fax | 541-889-7873
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | STEVE JENSEN
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Credential |
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Telephone | 541-889-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | OR
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Taxonomy #4
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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 #5
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 700087
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License Number State | OR
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Taxonomy #6
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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 | OR
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