Provider Demographics
NPI:1154455350
Name:CENTER FOR HUMAN DEVELOPMENT, INC
Entity Type:Organization
Organization Name:CENTER FOR HUMAN DEVELOPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-962-8812
Mailing Address - Street 1:2301 COVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850
Mailing Address - Country:US
Mailing Address - Phone:541-962-8800
Mailing Address - Fax:541-963-5272
Practice Address - Street 1:2301 COVE AVENUE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850
Practice Address - Country:US
Practice Address - Phone:541-962-8800
Practice Address - Fax:541-963-5272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR HUMAN DEVELOPMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-16
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCH-0000029251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR097436Medicaid
ORR112493Medicare PIN