| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 850 Swing Ln, Medford, Oregon |
| Authorized Official Name and Position | Michael Sewitsky (FINANCE MANAGER) |
| Authorized Official Contact | 5418588170 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3587 Heathrow Way Medford OR 97504-4004 Ph: (541) 858-8170 | 850 Swing Ln Medford OR 97501-1790 Ph: (541) 858-8170 |
| NPI Number | 1255835104 |
|---|---|
| Provider Enumeration Date | 03/23/2018 |
| Last Update Date | 03/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255835104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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