Organization
PIONEER GUEST HOME II, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL PERRY RODDEY OWNER (LICENSED ADMINISTRATOR)
(541) 263-0897
Entity
Organization
Contact information
Practice address
101 E MAIN ST, ENTERPRISE, OR 97828-1381
(541) 426-4222
(541) 426-6550
Mailing address
PO BOX 326, ENTERPRISE, OR 97828-0326
(541) 426-4222
(541) 426-6550
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
300024
OR
Other
Enumeration date
06/12/2013
Last updated
06/12/2013
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