Basic Information
| Provider Information | |||||||||
| NPI: | 1588956551 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTERN OREGON HUMAN SERVICES CONSORTIUM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970582107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412982101 | ||||||||
| FaxNumber: | 5412987996 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | THE DALLES | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970582107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412982101 | ||||||||
| FaxNumber: | 5412987996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2011 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | FINANCIAL ASSISTANCE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5414903263 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | OR | Y | Agencies | Community/Behavioral Health |
No ID Information.