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General NPI Number Information
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NPI Number | 1699745794
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Entity Type | Organization
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Legal Business Name | MID-COLUMBIA CENTER FOR LIVING
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 1060 WEBBER ST
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City | THE DALLES
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State | OR
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Zip | 97058-3749
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Country | US
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Telephone | 541-296-5452
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Fax | 541-296-9418
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Provider Business Mailing Address
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Address Line | 1060 WEBBER ST
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City | THE DALLES
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State | OR
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Zip | 97058-3749
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Country | US
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Telephone | 541-296-5452
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Fax | 541-296-9418
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Authorized Official
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Title or Position | DEPUTY DIRECTOR
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Name | ALEXANDER BARTON
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Credential |
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Telephone | 541-296-5452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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