Provider Demographics
NPI:1235220153
Name:JULIETTE'S HOUSE CHILD ABUSE ASSESSMENT CENTER
Entity Type:Organization
Organization Name:JULIETTE'S HOUSE CHILD ABUSE ASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-435-1550
Mailing Address - Street 1:1075 SW CEDARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6818
Mailing Address - Country:US
Mailing Address - Phone:503-435-1550
Mailing Address - Fax:503-435-1435
Practice Address - Street 1:1075 SW CEDARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6818
Practice Address - Country:US
Practice Address - Phone:503-435-1550
Practice Address - Fax:503-435-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150468OtherOREGON HEATH PLAN