1417991258 NPI number — PENDLETON ACADMIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417991258 NPI number — PENDLETON ACADMIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENDLETON ACADMIES
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:
EASTERN OREGON CHILDREN'S MULTI-TREATMENT CENTER
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:
1417991258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
622 AIRPORT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENDLETON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97801-4598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-276-0057
Provider Business Mailing Address Fax Number:
541-276-1704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
622 AIRPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENDLETON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97801-4598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-276-0057
Provider Business Practice Location Address Fax Number:
541-276-1704
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EDVALSON
Authorized Official First Name:
P.
Authorized Official Middle Name:
TERRY
Authorized Official Title or Position:
INTERIM EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
541-966-7810

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320800000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2055X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 312056 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: S20475 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312041 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312048 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 313437 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: PCG023 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312064 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 313205 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 182229 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 312040 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com