1376546291 NPI number — WILLAMETTE FAMILY, INC

Table of content: (NPI 1376546291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376546291 NPI number — WILLAMETTE FAMILY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLAMETTE FAMILY, INC
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:
WILLAMETTE FAMILY TREATMENT SERVICES
Provider Other Organization Name Type Code:
4
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:
1376546291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
687 CHESHIRE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97402-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-684-4100
Provider Business Mailing Address Fax Number:
541-684-4156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
687 CHESHIRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97402-5060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-684-4100
Provider Business Practice Location Address Fax Number:
541-684-4156
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
541-914-1036

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251V00000X , with the licence number: 1739 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3245S0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 008891 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500678005 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 247573 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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