MEDICARE: KLAMATH CHILD AND FAMILY TREATMENT CENTER

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	320800000X	Mental Illness Community Based Residential Treatment Facility		OR

Other Identifiers

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

General Provider Information

NPI Number	:	1992949796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLAMATH CHILD AND FAMILY TREATMENT CENTER

Provider Business Mailing Address
First Line	:	2210 N ELDORADO AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-6418
Country	:	US
Telephone Number	:	541-883-1030
Fax Number	:	541-884-2338

Provider Business Practice Location Address
First Line	:	705 WASHBURN WAY
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-3648
Country	:	US
Telephone Number	:	541-883-1030
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ELIZABETH MADDALENA
Credential	:
Telephone Number	:	541-883-1030

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/22/2026

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