Provider Demographics
NPI:1275954513
Name:MID-COLUMBIA CENTER FOR LIVING
Entity Type:Organization
Organization Name:MID-COLUMBIA CENTER FOR LIVING
Other - Org Name:MCCFL THE DALLES OCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-296-5452
Mailing Address - Street 1:1060 WEBBER ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3749
Mailing Address - Country:US
Mailing Address - Phone:541-296-5452
Mailing Address - Fax:541-296-9418
Practice Address - Street 1:1040 WEBBER ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3749
Practice Address - Country:US
Practice Address - Phone:541-296-5452
Practice Address - Fax:541-296-9418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-COLUMBIA CENTER FOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-03
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health