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Organization

KLAMATH LAKE COUNTY YOUTH RANCH

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WILLIAM THOMPSON (PROGRAM DIRECTOR)
(541) 545-6742
Entity
Organization

Contact information

Practice address
5800 HAPPY HOLLOW LN, BONANZA, OR 97623-7714
(541) 545-6742
Mailing address
5800 HAPPY HOLLOW LN, BONANZA, OR 97623-7714
(541) 545-6742

Taxonomy

Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
0138
OR

Other

Enumeration date
11/27/2013
Last updated
11/27/2013
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