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General NPI Number Information
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NPI Number | 1669000865
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Entity Type | Organization
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Legal Business Name | MID-VALLEY HEALTHCARE, INC.
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 111 N MAIN ST STE B
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City | LEBANON
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State | OR
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Zip | 97355-2869
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Country | US
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Telephone | 541-451-6388
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1193
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City | CORVALLIS
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State | OR
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Zip | 97339-1193
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSEPH M. CAHILL III
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Credential |
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Telephone | 541-602-4907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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