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215 Se Jackson St Roseburg OR 97470-3341 | |
| (541) 464-6404 | |
| (541) 464-6420 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 215 Se Jackson St, Roseburg, Oregon |
| Authorized Official Name and Position | Christina L Mcmahan (JUVENILE DEPARTMENT DIRECTOR) |
| Authorized Official Contact | 5414404415 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1036 Se Douglas Ave Justice Building, Room 203 Roseburg OR 97470-3301 Ph: (541) 464-6404 | 215 Se Jackson St Roseburg OR 97470-3341 Ph: (541) 464-6404 |
| NPI Number | 1366697690 |
|---|---|
| Provider Enumeration Date | 12/01/2008 |
| Last Update Date | 12/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366697690 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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