Organization
VASORCC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WOLFGANG L AGOTTA M CAS, CHT/RHT, CRPS (PRIMARY/ASSESSMENT THERAPIST)
(541) 826-2111
Entity
Organization
Contact information
Practice address
8495 CRATER LAKE HWY, WHITE CITY, OR 97503-3011
(541) 826-2111
Mailing address
839 N MAIN ST, ASHLAND, OR 97520-1713
(541) 261-8349
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
4305
MI
Other
Enumeration date
08/19/2006
Last updated
08/22/2020
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