| NPI | 1669437497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMMY GILSTRAP Clinical Director 541-330-8671 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OR 08-00002864) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2022-07-21 |