Basic Information
| Provider Information | |||||||||
| NPI: | 1225403744 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOOKING GLASS COMMUNITY SERVICES - PATHWAYS BOYS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1790 W 11TH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974023758 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 550 RIVER RD | ||||||||
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| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974043212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417432611 | ||||||||
| FaxNumber: | 5418680340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2015 | ||||||||
| LastUpdateDate: | 12/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | HALL | ||||||||
| AuthorizedOfficialFirstName: | KELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 5416862688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3245S0500X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
No ID Information.