MEDICARE: RICARDO OLALDE MS, CADC III, CRM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	96-04-144	OR

General Provider Information

NPI Number	:	1013329911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO OLALDE MS, CADC III, CRM

Provider Business Mailing Address
First Line	:	PO BOX 356
Second Line	:
City	:	FALLS CITY
State	:	OR
Zip	:	97344-0356
Country	:	US
Telephone Number	:	503-373-7758
Fax Number	:	503-301-6721

Provider Business Practice Location Address
First Line	:	FREEDOM & RECOVERY PROGRAM A D PROGRAM
Second Line	:	3405 DEER PARK DR. SE
City	:	SALEM
State	:	OR
Zip	:	97310-0001
Country	:	US
Telephone Number	:	503-373-7758
Fax Number	:	503-378-6525

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	05/27/2014

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