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NPI Code Detail

MEDICARE: JASPER MOUNTAIN

MEDICARE: JASPER MOUNTAIN
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
1322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityOR
2323P00000XPsychiatric Residential Treatment Facility
3385HR2055XChild Mental Illness Respite CareOR
4320800000XMental Illness Community Based Residential Treatment FacilityOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497821680
Entity Type Code : Organization
Provider Name (Legal Business Name) : JASPER MOUNTAIN
Provider Business Mailing Address
First Line : 37875 JASPER LOWELL RD
Second Line :
City : JASPER
State : OR
Zip : 97438-9751
Country : US
Telephone Number : 541-747-1235
Fax Number : 541-747-4722
Provider Business Practice Location Address
First Line : 37875 JASPER LOWELL RD
Second Line :
City : JASPER
State : OR
Zip : 97438-9751
Country : US
Telephone Number : 541-747-1235
Fax Number : 541-747-4722
Authorized Official
Title or Position : COMPLIANCE SPECIALIST
Name : CARITA CHANTEL LIVELY
Credential :
Telephone Number : 541-747-1235
Provider Enumeration Date : 11/28/2006
Last Update Date : 03/08/2024

Similar Medicare Providers

1336073550 — MR. DYLAN SHANNON GRIFFIN
Practice Location Address:
37875 JASPER LOWELL RD
JASPER, OR
97438-9751
Practice Phone: 541-747-1235
Practice Fax:
1386576171 — SYLVIA WOODS
Practice Location Address:
37875 JASPER LOWELL RD
JASPER, OR
97438-9751
Practice Phone: 541-741-7402
Practice Fax:
1871625830 — MS. LILIANA DE ALMEIDA LYNN MFT
Practice Location Address:
37875 JASPER LOWELL RD
JASPER, OR
97438-9751
Practice Phone: 541-747-1235
Practice Fax: 541-747-4722
1609076009 — DR. DAVID L ZIEGLER PH.D.
Practice Location Address:
37875 JASPER LOWELL RD
JASPER, OR
97438-9751
Practice Phone: 541-747-1235
Practice Fax:
1841480845 — MR. ANDREW TYLER B.A.; QMHP
Practice Location Address:
37875 JASPER LOWELL RD
JASPER, OR
97438-9751
Practice Phone: 541-747-1235
Practice Fax: 541-747-4722
1043400096 — MRS. EDEN HUSTON M.S.
Practice Location Address:
37875 JASPER LOWELL RD
JASPER, OR
97438-9751
Practice Phone: 541-747-1235
Practice Fax: 541-747-4722

Directions to “JASPER MOUNTAIN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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