Organization
LONGEVITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JAMIE E EHRKE LMT (OWNER)
(503) 368-3800
Entity
Organization
Contact information
Practice address
123 LANEDA AVE, MANZANITA, OR 97130
(503) 368-3800
Mailing address
PO BOX 1313, MANZANITA, OR 97130-1313
(503) 368-3800
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
14374
OR
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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