Provider Demographics
NPI:1114594264
Name:JACKSON COUNTY CHILD ABUSE TASK FORCE INC
Entity Type:Organization
Organization Name:JACKSON COUNTY CHILD ABUSE TASK FORCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITZEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-734-5437
Mailing Address - Street 1:816 W. 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-734-5437
Mailing Address - Fax:541-618-1094
Practice Address - Street 1:816 WEST 10TH STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-734-5437
Practice Address - Fax:541-618-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232518Medicaid