=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649133927
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UMPQUA COMMUNITY DEVELOPMENT CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 SE KANE ST
-----------------------------------------------------
City | ROSEBURG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97470-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-673-4909
-----------------------------------------------------
Fax | 541-673-5023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 SE KANE ST
-----------------------------------------------------
City | ROSEBURG
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97470-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-673-4909
-----------------------------------------------------
Fax | 541-673-5023
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | ERICA MILLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 541-679-4909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------