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General NPI Number Information
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NPI Number | 1720023807
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Entity Type | Organization
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Legal Business Name | DEPT. OF HUMAN SRVCS/OFFICE OF FIN. SRVCS DBA: IRS/EOPC/EOTC/OSH/OSH-P
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 2525 WESTGATE
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City | PENDLETON
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State | OR
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Zip | 97801-9613
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Country | US
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Telephone | 541-276-0820
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Fax | 541-276-1147
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Provider Business Mailing Address
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Address Line | PO BOX 14900
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City | SALEM
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State | OR
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Zip | 97309-5016
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Country | US
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Telephone | 503-945-9469
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Fax | 503-947-1007
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Authorized Official
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Title or Position | INSTITUTIONAL REVENUE SECTION MGR.
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Name | RUSSELL R. KITTRELL
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Credential |
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Telephone | 503-945-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 6021
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License Number State | OR
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