Organization
ELDERLY AND DISABLED SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY MICHAEL MCPHEE (PROVIDER/OWNER)
(541) 261-1991
Entity
Organization
Contact information
Practice address
3126 STATE ST STE 100, MEDFORD, OR 97504-8665
(458) 225-9358
Mailing address
4439 HAMRICK RD, CENTRAL POINT, OR 97502-2816
(541) 261-1991
(541) 631-3424
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500788139
—
OR
05
—
500791695
—
OR
Enumeration date
03/30/2022
Last updated
12/16/2024
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