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 |