Provider Demographics
NPI:1467006668
Name:WALLOWA VALLEY CENTER FOR WELLNESS
Entity Type:Organization
Organization Name:WALLOWA VALLEY CENTER FOR WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JEWEL
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-426-0801
Mailing Address - Street 1:PO BOX 268
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:OR
Mailing Address - Zip Code:97828-0268
Mailing Address - Country:US
Mailing Address - Phone:541-426-4524
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:OR
Practice Address - Zip Code:97828-1245
Practice Address - Country:US
Practice Address - Phone:541-426-0801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty