Organization
JASPER MOUNTAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARITA CHANTEL LIVELY (COMPLIANCE SPECIALIST)
(541) 747-1235
Entity
Organization
Contact information
Practice address
37875 JASPER LOWELL RD, JASPER, OR 97438-9751
(541) 747-1235
(541) 747-4722
Mailing address
37875 JASPER LOWELL RD, JASPER, OR 97438-9751
(541) 747-1235
(541) 747-4722
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
OR
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
OR
323P00000X
Psychiatric Residential Treatment Facility
—
—
385HR2055X
Child Mental Illness Respite Care
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178087
—
OR
05
—
313495
—
OR
Enumeration date
11/28/2006
Last updated
03/08/2024
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