1366697690 NPI number — COUNTY OF DOUGLAS

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 1366697690 NPI number — COUNTY OF DOUGLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF DOUGLAS
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:
6
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:
1366697690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1036 SE DOUGLAS AVE
Provider Second Line Business Mailing Address:
JUSTICE BUILDING, ROOM 203
Provider Business Mailing Address City Name:
ROSEBURG
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97470-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-464-6404
Provider Business Mailing Address Fax Number:
541-464-6420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 SE JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEBURG
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97470-3341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-464-6404
Provider Business Practice Location Address Fax Number:
541-464-6420
Provider Enumeration Date:
12/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCMAHAN
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
JUVENILE DEPARTMENT DIRECTOR
Authorized Official Telephone Number:
541-440-4415

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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