Provider Demographics
NPI:1386855344
Name:CATHOLIC COMMUNITY SERVICES OF THE MID WILLAMETTE VALLEY CENTRAL OREGO
Entity Type:Organization
Organization Name:CATHOLIC COMMUNITY SERVICES OF THE MID WILLAMETTE VALLEY CENTRAL OREGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL AGENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:503-485-8978
Mailing Address - Street 1:3737 PORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:503-485-8978
Mailing Address - Fax:
Practice Address - Street 1:3737 PORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303-2511
Practice Address - Country:US
Practice Address - Phone:503-485-8978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR251B00000XMedicare UPIN