Provider Demographics
NPI:1417375270
Name:EDUCATIONAL TRAINING PROGRAM INC.
Entity Type:Organization
Organization Name:EDUCATIONAL TRAINING PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-915-6766
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-0069
Mailing Address - Country:US
Mailing Address - Phone:541-915-6766
Mailing Address - Fax:503-723-9964
Practice Address - Street 1:15420 FORSYTHE RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8742
Practice Address - Country:US
Practice Address - Phone:541-915-6766
Practice Address - Fax:503-723-9964
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDUCATIONAL TRAINING PROGRAM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities