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147 Sw Court St Dallas OR 97338-3112 | |
| (503) 304-4358 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 147 Sw Court St, Dallas, Oregon |
| Authorized Official Name and Position | Justin Scott Nielsen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5033044358 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 20674 Keizer OR 97307-0674 Ph: (503) 304-4358 | 147 Sw Court St Dallas OR 97338-3112 Ph: (503) 304-4358 |
| NPI Number | 1164111472 |
|---|---|
| Provider Enumeration Date | 05/03/2023 |
| Last Update Date | 12/15/2023 |
| Certification Date | 12/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164111472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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