Organization
COLUMBIACARE SERVICES
Active
Other names
Driftwood Lodge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT C BECKETT (EXECUTIVE DIRECTOR)
(541) 858-8170
Entity
Organization
Contact information
Practice address
29413 RUSSELL ST, GOLD BEACH, OR 97444-7748
(541) 247-6566
(541) 247-6549
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504
(541) 858-8170
(541) 858-8167
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
717
OR
323P00000X
Psychiatric Residential Treatment Facility
Primary
717
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276114
—
OR
01
—
513857
DW SERVICE PMT
OR
Enumeration date
10/09/2006
Last updated
05/19/2009
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