Basic Information
| Provider Information | |||||||||
| NPI: | 1518244888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN OREGON ADOLESCENT STUDY & TREATMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1913 MEADE ST | ||||||||
| Address2: | |||||||||
| City: | NORTH BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974593432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417564508 | ||||||||
| FaxNumber: | 5417564550 | ||||||||
| Practice Location | |||||||||
| Address1: | 1913 MEADE ST | ||||||||
| Address2: | |||||||||
| City: | NORTH BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974593432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417564508 | ||||||||
| FaxNumber: | 5417564550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2011 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHORB | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
| AuthorizedOfficialMiddleName: | ELIZABETH | ||||||||
| AuthorizedOfficialTitleorPosition: | TREATMENT FOSTER CARE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5417564508 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | B.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253J00000X | N | Agencies | Foster Care Agency | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.