| NPI | 1366953861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANA JORGENSEN Authorized Official 541-322-1794 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2021-09-16 |