# BLUE DIAMOND ESTATES

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1962090951
- **Authorized official:** MARY JOHNSON (QMHA)
- **Authorized official phone:** (541) 751-5040

## Contact information

- **Practice address:** 87326 MCTIMMONS LN, BANDON, OR 97411-8285
- **Practice address phone:** (541) 217-4006
- **Practice address fax:** (541) 347-7555
- **Mailing address:** 87326 MCTIMMONS LN, BANDON, OR 97411-8285
- **Mailing address phone:** (541) 217-4006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/05/2021
- **Last updated:** 01/05/2021