Organization
COLUMBACARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE DAVID SEWITSKY (FINANCE MANAGER)
(541) 858-8170
Entity
Organization
Contact information
Practice address
210 COVE LANE, BROOKINGS, OR 97415
(541) 858-8170
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
07863
OR
323P00000X
Psychiatric Residential Treatment Facility
Primary
07863
OR
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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