Basic Information
| Provider Information | |||||||||
| NPI: | 1326240037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY WORKS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W MAIN ST | ||||||||
| Address2: | #3D | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975012744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417792393 | ||||||||
| FaxNumber: | 5417793317 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W MAIN ST | ||||||||
| Address2: | #3D | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975012744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417792393 | ||||||||
| FaxNumber: | 5417793317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 05/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | EIDSON | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUSINESS | ||||||||
| AuthorizedOfficialTelephone: | 5417792393 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | OR | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 127014 | 05 | OR | MEDICAID |