Provider Demographics
NPI:1376199398
Name:CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON
Entity Type:Organization
Organization Name:CONFEDERATED TRIBES OF THE WARM SPRINGS RESERVATION OF OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:STACONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-553-3232
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:WARM SPRINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97761-3001
Mailing Address - Country:US
Mailing Address - Phone:541-777-2663
Mailing Address - Fax:541-777-2662
Practice Address - Street 1:2124 WARM SPRINGS ST.
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97761
Practice Address - Country:US
Practice Address - Phone:541-777-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty