Basic Information
| Provider Information | |||||||||
| NPI: | 1487809091 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BESTCARE TREATMENT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 SW C STREET | ||||||||
| Address2: | PO BOX 1710 | ||||||||
| City: | REDMOND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977568527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415049577 | ||||||||
| FaxNumber: | 5415042361 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 SW C STREET | ||||||||
| Address2: | |||||||||
| City: | MADRAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415049577 | ||||||||
| FaxNumber: | 5415042361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2008 | ||||||||
| LastUpdateDate: | 11/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | TRELEVAN | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5415049577 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | OR | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 251S00000X | OR | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 210848 | 05 | OR | MEDICAID |