Organization
COLUMBIACARE SERVICES
Active
Organization
COLUMBIACARE SERVICES
Active
Other names
Johnson Creek
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT C BECKETT (EXECUTIVE DIRECTOR)
(541) 858-8170
Entity
Organization
Contact information
Practice address
2808 SE BALFOUR ST, MILWAUKIE, OR 97222-6426
(503) 659-2575
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504
(541) 858-8170
(541) 858-8167
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500615590
—
OR
Enumeration date
09/02/2009
Last updated
08/20/2010
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