Basic Information
| Provider Information | |||||||||
| NPI: | 1982952958 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHEHALEM YOUTH AND FAMILY SERVICES | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636 | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971320636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035384874 | ||||||||
| FaxNumber: | 5035381271 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971322909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035384874 | ||||||||
| FaxNumber: | 5035381271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2012 | ||||||||
| LastUpdateDate: | 08/24/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CATHERS-SEYMOUR | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5035384874 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.