Provider Demographics
NPI:1275085128
Name:NORTHWEST YOUTH DISCOVERY
Entity Type:Organization
Organization Name:NORTHWEST YOUTH DISCOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STREETER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MED
Authorized Official - Phone:541-647-9609
Mailing Address - Street 1:70 SW CENTURY DR STE 100-118
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3557
Mailing Address - Country:US
Mailing Address - Phone:541-647-9609
Mailing Address - Fax:541-389-1648
Practice Address - Street 1:61850 DOBBIN RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-9536
Practice Address - Country:US
Practice Address - Phone:541-647-9609
Practice Address - Fax:541-389-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children