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5775 Red Leaf Dr S Apt 213 Salem OR 97306-3023 | |
| (505) 269-2988 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 5775 Red Leaf Dr S Apt 213, Salem, Oregon |
| Authorized Official Name and Position | Cheryl E Benedetto (OWNER) |
| Authorized Official Contact | 5052692988 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5775 Red Leaf Dr S Apt 213 Salem OR 97306-3023 Ph: (505) 269-2988 | 5775 Red Leaf Dr S Apt 213 Salem OR 97306-3023 Ph: (505) 269-2988 |
| NPI Number | 1396397618 |
|---|---|
| Provider Enumeration Date | 07/16/2019 |
| Last Update Date | 12/28/2024 |
| Certification Date | 12/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396397618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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