1356628119 NPI number — MARION COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1356628119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356628119 NPI number — MARION COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION COUNTY HEALTH 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:
ADULT ALCOHOL AND DRUG TREATMENT
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:
1356628119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97305-7668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-362-1399
Provider Business Mailing Address Fax Number:
503-362-4409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2035 DAVCOR ST SE
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:
97302-1595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-362-1399
Provider Business Practice Location Address Fax Number:
503-362-4409
Provider Enumeration Date:
11/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MORENO
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
KRISTIE
Authorized Official Title or Position:
CASE MANAGEMENT
Authorized Official Telephone Number:
503-362-1399

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  190702 , 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)





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