Organization
WALLOWA VALLEY CENTER FOR WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTAY JETT (EXECUTIVE DIRECTOR)
(541) 426-4524
Entity
Organization
Contact information
Practice address
606 MEDICAL PKWY, ENTERPRISE, OR 97828-5140
(541) 426-4524
(541) 426-3035
Mailing address
PO BOX 268, ENTERPRISE, OR 97828-0268
(541) 426-4524
(541) 426-3035
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210511
—
OR
Enumeration date
01/14/2009
Last updated
11/03/2024
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