Provider Demographics
NPI:1245432509
Name:COMMUNITY WORKS, INC.
Entity Type:Organization
Organization Name:COMMUNITY WORKS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:EIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-779-2393
Mailing Address - Street 1:201 W MAIN ST
Mailing Address - Street 2:#3D
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2744
Mailing Address - Country:US
Mailing Address - Phone:541-779-2393
Mailing Address - Fax:541-779-3317
Practice Address - Street 1:201 W MAIN ST
Practice Address - Street 2:#3D
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2744
Practice Address - Country:US
Practice Address - Phone:541-779-2393
Practice Address - Fax:541-779-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164979Medicaid