Provider Demographics
NPI:1356628119
Name:MARION COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MARION COUNTY HEALTH DEPARTMENT
Other - Org Name:ADULT ALCOHOL AND DRUG TREATMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:CASE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KRISTIE
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:CADCI
Authorized Official - Phone:503-362-1399
Mailing Address - Street 1:PO BOX 17668
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-7668
Mailing Address - Country:US
Mailing Address - Phone:503-362-1399
Mailing Address - Fax:503-362-4409
Practice Address - Street 1:2035 DAVCOR ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1595
Practice Address - Country:US
Practice Address - Phone:503-362-1399
Practice Address - Fax:503-362-4409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR190702324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility