Organization
SEAN'S PLACE, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANDREA LYNN WILLIAMS MA (EXECUTIVE PROGRAM DIRECTOR)
(541) 995-5188
Entity
Organization
Contact information
Practice address
930 HAMMER ST, HARRISBURG, OR 97446-9590
(541) 995-5188
(541) 995-5061
Mailing address
930 HAMMER ST, HARRISBURG, OR 97446-9590
(541) 995-5188
(541) 995-5061
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500620453
—
OR
Enumeration date
03/13/2012
Last updated
03/13/2012
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