Organization
OREGON 180
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN BARNARD MWS (PROGRAM MANAGER)
(541) 621-3053
Entity
Organization
Contact information
Practice address
725 W 14TH ST, MEDFORD, OR 97501-3429
(541) 621-3053
Mailing address
725 W 14TH ST, MEDFORD, OR 97501-3429
(541) 621-3053
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/03/2016
Last updated
01/03/2016
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