Organization
KLAMATH YOUTH DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY HANNA WALDRON M.S (TREATMENT SPECIALIST)
(541) 883-1030
Entity
Organization
Contact information
Practice address
2210 N ELDORADO AVE, KLAMATH FALLS, OR 97601
(541) 883-1030
Mailing address
1527 LOOKOUT AVE, KLAMATH FALLS, OR 97601
(541) 892-2221
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
223354
—
OR
Enumeration date
10/25/2013
Last updated
10/25/2013
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