Organization
BLUE DIAMOND ESTATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JOHNSON (QMHA)
(541) 751-5040
Entity
Organization
Contact information
Practice address
87326 MCTIMMONS LN, BANDON, OR 97411-8285
(541) 217-4006
(541) 347-7555
Mailing address
87326 MCTIMMONS LN, BANDON, OR 97411-8285
(541) 217-4006
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
527511
—
OR
Enumeration date
01/05/2021
Last updated
01/05/2021
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