Organization
LA GRANDE SD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN ALEJANDRO GONZALEZ (MEDICAID COORDINATOR)
(541) 663-3220
Entity
Organization
Contact information
Practice address
1305 N WILLOW ST, LA GRANDE, OR 97850-3822
(541) 663-3200
(541) 663-3215
Mailing address
1305 N WILLOW ST, LA GRANDE, OR 97850-3822
(541) 663-3200
(541) 663-3215
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Enumeration date
11/13/2025
Last updated
11/13/2025
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