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NPI Code Detail

MEDICARE: COLUMBIACARE SERVICES

MEDICARE: COLUMBIACARE SERVICES
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
1320800000XMental Illness Community Based Residential Treatment Facility
2323P00000XPsychiatric Residential Treatment Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1500605089OTHERORRESIDENTIAL PROVIDER

General Provider Information

NPI Number : 1912214081
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLUMBIACARE SERVICES
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number : 541-858-8170
Fax Number : 541-858-8167
Provider Business Practice Location Address
First Line : 20025 MOSSY MEADOWS AVE
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-7136
Country : US
Telephone Number : 541-858-8170
Fax Number : 541-858-8167
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. ROBERT C BECKETT
Credential :
Telephone Number : 541-858-8170
Provider Enumeration Date : 09/09/2010
Last Update Date : 09/09/2010

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Directions to “COLUMBIACARE SERVICES ” Practice Location

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