| NPI | 1992211858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBI JOLYNE SURPLUS Revenue Cycle Manager 541-516-4099 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2025-09-02 |