Provider Demographics
NPI:1467573485
Name:MT EMILY SAFE CENTER
Entity Type:Organization
Organization Name:MT EMILY SAFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-963-0602
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-0146
Mailing Address - Country:US
Mailing Address - Phone:541-963-0602
Mailing Address - Fax:541-962-0345
Practice Address - Street 1:2107 3RD ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2242
Practice Address - Country:US
Practice Address - Phone:541-963-0602
Practice Address - Fax:541-962-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR67369182251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR57169744OtherBLUE CROSS BLUE SHIELD
OR287127Medicaid