1548461668 NPI number — CATHOLIC COMMUNITY SERVICES OF THE MID WILLAMETTE VALLEY CENTRAL COAST

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 1548461668 NPI number — CATHOLIC COMMUNITY SERVICES OF THE MID WILLAMETTE VALLEY CENTRAL COAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC COMMUNITY SERVICES OF THE MID WILLAMETTE VALLEY CENTRAL COAST
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:
Provider Other Organization Name Type Code:
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:
1548461668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEIZER
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97307-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-856-7061
Provider Business Mailing Address Fax Number:
503-463-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3737 PORTLAND RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97303-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-856-7061
Provider Business Practice Location Address Fax Number:
503-463-6280
Provider Enumeration Date:
05/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
LORI
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
ASSOCIATE PROGRAM DIRECTOR
Authorized Official Telephone Number:
503-856-7061

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com