Organization
WALLOWA VALLEY CENTER FOR WELLNESS
Active
Other names
Wallowa River House
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTAY JETT (EXECUTIVE DIRECTOR)
(541) 426-4524
Entity
Organization
Contact information
Practice address
601 WHISKEY CREEK RD, WALLOWA, OR 97885-7129
(541) 886-3142
Mailing address
PO BOX 268, ENTERPRISE, OR 97828-0268
(541) 426-4524
(541) 426-3035
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
984
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
517796
—
OR
Enumeration date
12/11/2008
Last updated
11/03/2024
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