Organization
CHILDREN FARM HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALKER COOK VAVE (SKILLS TRAINER)
(541) 758-5944
Entity
Organization
Contact information
Practice address
4455 NE HIGHWAY 20, CORVALLIS, OR 97330-9695
(541) 757-1852
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
101Y00000X
OR
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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