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General NPI Number Information
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NPI Number | 1598458390
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Entity Type | Organization
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Legal Business Name | BEND FAMILY FRIENDS LLC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 61940 PETTIGREW RD
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City | BEND
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State | OR
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Zip | 97702-2418
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Country | US
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Telephone | 458-281-0612
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Fax |
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Provider Business Mailing Address
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Address Line | 61940 PETTIGREW RD
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City | BEND
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State | OR
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Zip | 97702-2418
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Country | US
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Telephone | 458-281-0612
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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 | MR. GUNNAR JAY PETERSON
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Credential |
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Telephone | 360-624-1495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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