Basic Information
| Provider Information | |||||||||
| NPI: | 1487881959 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARION COUNTY HEALTH DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3180 CENTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885357 | ||||||||
| FaxNumber: | 5033612789 | ||||||||
| Practice Location | |||||||||
| Address1: | 2435 GREENWAY DR NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973014535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035885357 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 06/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDS | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | BEHAVIORAL HEALTH DIVSION DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5035885357 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MARION COUNTY OREGON POLITICAL SUBDIVISION STATE OF OREGON | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | 514449 | OR | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 514449 | 05 | OR | MEDICAID |