| Center For Human Development, Inc. | |
|
2301 Cove Avenue Lagrande OR 97850 | |
| (541) 962-8800 | |
| (541) 963-5272 |
| Full Name | Center For Human Development, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2301 Cove Avenue, Lagrande, Oregon |
| Authorized Official Name and Position | Veronica Wood (AUTHORIZED DESIGNEE) |
| Authorized Official Contact | 5419628812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Human Development, Inc. 2301 Cove Avenue Lagrande OR 97850 Ph: (541) 962-8800 | Center For Human Development, Inc. 2301 Cove Avenue Lagrande OR 97850 Ph: (541) 962-8800 |
| NPI Number | 1114051315 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 09/17/2012 |
| Medicare PECOS PAC ID | 3678578663 |
|---|---|
| Medicare Enrollment ID | O20130410000378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114051315 | NPI | - | NPPES |
| 164930 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Lynn A Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407866221 PECOS PAC ID: 4183702533 Enrollment ID: I20080424000716 |
| Provider Name | Francis Edward Szumski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457347965 PECOS PAC ID: 4688723315 Enrollment ID: I20100727000284 |
| Provider Name | Joelene K Peasley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700808706 PECOS PAC ID: 2365699964 Enrollment ID: I20120905000262 |
| Provider Name | Virginia Claire Elder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235215229 PECOS PAC ID: 0446401632 Enrollment ID: I20121116000288 |
| Provider Name | Lori Russell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538331780 PECOS PAC ID: 7214208933 Enrollment ID: I20170728003194 |
| Provider Name | Daisy L Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790143162 PECOS PAC ID: 1052615374 Enrollment ID: I20170822004167 |
| Provider Name | Dale Mcqueeney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679958300 PECOS PAC ID: 1557678976 Enrollment ID: I20200709000122 |
| Provider Name | Karyn Marie Ertel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932184504 PECOS PAC ID: 8022065929 Enrollment ID: I20210824003702 |