=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629168166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADOLESCENT DAY TREATMENT CENTER INC OF DOUGLAS COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 671 S.W. MAIN
-----------------------------------------------------
City | WINSTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97496
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-679-6129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2259
-----------------------------------------------------
City | WINSTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97496-2259
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-679-6129
-----------------------------------------------------
Fax | 541-679-5285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM DIRECTOR
-----------------------------------------------------
Name | MS. BONNA M MEYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-679-6129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | CERTIFICATE APPROVAL
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | CERTIFCATE OF APPROV
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------