1174392260 NPI number — DESCHUTES COUNTY JUVENILE COMMUNITY JUSTICE DEPARTMENT

Table of content: (NPI 1174392260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174392260 NPI number — DESCHUTES COUNTY JUVENILE COMMUNITY JUSTICE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESCHUTES COUNTY JUVENILE COMMUNITY JUSTICE DEPARTMENT
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:
1174392260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6005
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97708-6005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-388-6671
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63360 NW BRITTA STREET
Provider Second Line Business Practice Location Address:
BUILDING 1
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-388-6671
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
541-322-7678

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; 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