Organization
ELDERHEALTH & LIVING
Active
Other names
Summit South
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NANCY J KOLL (CFO)
(541) 747-4858
Entity
Organization
Contact information
Practice address
382 S 58TH ST, SPRINGFIELD, OR 97478-7623
(541) 747-4858
(541) 747-8314
Mailing address
382 S 58TH ST, SPRINGFIELD, OR 97478-7623
(541) 747-4858
(541) 747-8314
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
516389
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
516389
—
OR
Enumeration date
09/24/2012
Last updated
09/24/2012
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