Organization
CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON
Active
Other names
Grand Ronde Health and Wellness Center, Great Circle Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY D ROWE (EXECUTIVE DIRECTOR HEALTH SERVICES)
(503) 879-2075
Entity
Organization
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2236
(503) 879-5089
Mailing address
PO BOX 338, GRAND RONDE, OR 97347-0338
(503) 879-2236
(503) 879-5089
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
111N00000X
Chiropractor
—
—
1223G0001X
General Practice Dentistry
—
—
152W00000X
Optometrist
—
—
208D00000X
General Practice Physician
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
126883
OR
261QR0200X
Radiology Clinic/Center
445142
OR
291U00000X
Clinical Medical Laboratory
38D0862855
OR
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
—
—
333600000X
Pharmacy
1559
OR
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500786332
—
OR
Enumeration date
02/15/2007
Last updated
02/28/2024
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