Provider Demographics
NPI:1245598531
Name:LANE COUNTY COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:LANE COUNTY COMMUNITY HEALTH CENTERS
Other - Org Name:LANE COUNTY COMMUNITY HEALTH CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE/LPN
Authorized Official - Prefix:MS
Authorized Official - First Name:W
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:541-746-1405
Mailing Address - Street 1:3355 N DELTA HWY UNIT 108
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-5913
Mailing Address - Country:US
Mailing Address - Phone:541-746-1405
Mailing Address - Fax:
Practice Address - Street 1:3355 N DELTA HWY UNIT 108
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-5913
Practice Address - Country:US
Practice Address - Phone:541-746-1405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N/A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6560313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility