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General NPI Number Information
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NPI Number | 1629870688
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Entity Type | Organization
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Legal Business Name | EASTERN OREGON CENTER FOR INDEPENDENT LIVING
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1021 SW 5TH AVE
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City | ONTARIO
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State | OR
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Zip | 97914-3301
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Country | US
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Telephone | 541-889-3119
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Fax | 541-889-4647
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Provider Business Mailing Address
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Address Line | PO BOX 940
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City | ONTARIO
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State | OR
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Zip | 97914-0940
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Country | US
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Telephone | 541-889-3119
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Fax | 541-889-4647
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | WILLIAM KIRT TOOMBS SR.
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Credential | MMDS
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Telephone | 541-889-3119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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