| NPI | 1659885606 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS MATHIAS THOMAS CRAPSER Deputy Director 541-505-5659 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2020-04-20 |