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Organization
COLUMBIACARE SERVICES
Active
Organization
COLUMBIACARE SERVICES
Active
Other names
Driftwood Lodge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT C BECKETT (EXECUTIVE DIRECTOR)
(541) 858-8170
Entity
Organization
Contact information
Practice address
29413 RUSSELL ST, GOLD BEACH, OR 97444-7748
(541) 247-6566
(541) 247-6549
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504
(541) 858-8170
(541) 858-8167
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
717
OR
323P00000X
Psychiatric Residential Treatment Facility
Primary
717
OR
Other
Enumeration date
10/09/2006
Last updated
05/19/2009
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