Provider Demographics
NPI:1013567106
Name:WASCO COUNTY COMMUNITY CORRECTIONS
Entity Type:Organization
Organization Name:WASCO COUNTY COMMUNITY CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRITZ
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-506-2570
Mailing Address - Street 1:421 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2607
Mailing Address - Country:US
Mailing Address - Phone:541-506-2570
Mailing Address - Fax:541-506-2571
Practice Address - Street 1:421 E 7TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2607
Practice Address - Country:US
Practice Address - Phone:541-506-2570
Practice Address - Fax:541-506-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1639539315Medicaid