Organization
NEW WAVE RTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA WATSON (OWNER)
(541) 254-0630
Entity
Organization
Contact information
Practice address
2240 TERREL ST., MEDFORD, OR 97501
(458) 226-5347
(541) 327-4573
Mailing address
338 BLACK OAK DR., MEDFORD, OR 97504
(503) 789-5345
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/06/2022
Last updated
01/09/2024
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