Organization
PROFESSIONAL THERAPUETIC COMMUNITY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSSE L WATSON MS.CCSOFT (CEO)
(503) 391-7175
Entity
Organization
Contact information
Practice address
2905 RIVER RD S, SALEM, OR 97302-9754
(503) 391-7175
Mailing address
2905 RIVER RD S, SALEM, OR 97302-9754
(503) 391-7175
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500657056
—
OR
Enumeration date
08/19/2015
Last updated
08/19/2015
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