| Shangri-la Corporation | |
|
398 High St Eugene OR 97401-2310 | |
| (541) 344-1121 | |
| (541) 344-4210 |
| Full Name | Shangri-la Corporation |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 398 High St, Eugene, Oregon |
| Authorized Official Name and Position | Janet Yousey (CEO) |
| Authorized Official Contact | 5035811732 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shangri-la Corporation 398 High St Eugene OR 97401-2310 Ph: (541) 344-1121 | Shangri-la Corporation 398 High St Eugene OR 97401-2310 Ph: (541) 344-1121 |
| NPI Number | 1053858993 |
|---|---|
| Provider Enumeration Date | 01/31/2017 |
| Last Update Date | 08/10/2020 |
| Certification Date | 08/10/2020 |
| Medicare PECOS PAC ID | 5294086450 |
|---|---|
| Medicare Enrollment ID | O20180926004223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053858993 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Jessica Ann Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376796987 PECOS PAC ID: 8628219110 Enrollment ID: I20190314002366 |
| Provider Name | Annamarie H Mattox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366836579 PECOS PAC ID: 3476948803 Enrollment ID: I20220321002134 |
| Provider Name | Sandra Diane Munn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861853830 PECOS PAC ID: 0244682847 Enrollment ID: I20240119000421 |
| Provider Name | Karl Alan Porter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1932687472 PECOS PAC ID: 5799121018 Enrollment ID: I20240308003278 |
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