1245584572 NPI number — OPTIONS FOR SOUTHERN OREGON

Table of content: (NPI 1245584572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245584572 NPI number — OPTIONS FOR SOUTHERN OREGON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIONS FOR SOUTHERN OREGON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CRISIS RESOLUTION CENTER (CRC)
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245584572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 SW G ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANTS PASS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97526-2544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-476-2373
Provider Business Mailing Address Fax Number:
541-479-3514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 SW RAMSEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANTS PASS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97527-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-476-2373
Provider Business Practice Location Address Fax Number:
541-479-3514
Provider Enumeration Date:
11/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCCAFFERTY
Authorized Official First Name:
KARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
541-476-2373

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 700047 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 516354 . This is a "MEDICAID DMAP #" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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