| NPI | 1003762196 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA JORGENSEN Credentialing 541-322-1794 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2026-03-10 |
| Last Update Date | 2026-03-10 |