| NPI | 1790418176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI FOSSEN Chief Quality Officer 541-512-3912 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2022-07-05 |