| NPI | 1548999667 |
|---|---|
| Doing Business As | PINE STREET OPEN DOOR |
| Entity Type | Organization |
| Authorized Contact | JEANA MASTERS Ro 541-880-2011 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2023-02-06 |