# KLAMATH LAKE COUNTY YOUTH RANCH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528499696
- **Authorized official:** WILLIAM THOMPSON (PROGRAM DIRECTOR)
- **Authorized official phone:** (541) 545-6742

## Contact information

- **Practice address:** 5800 HAPPY HOLLOW LN, BONANZA, OR 97623-7714
- **Practice address phone:** (541) 545-6742
- **Mailing address:** 5800 HAPPY HOLLOW LN, BONANZA, OR 97623-7714
- **Mailing address phone:** (541) 545-6742

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 0138 | OR | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 11/27/2013