Provider Demographics
NPI:1467680777
Name:VETERAN AFFAIRSSOUTHERN OREGON REHABILITATION CENTER AND CLINIC
Entity Type:Organization
Organization Name:VETERAN AFFAIRSSOUTHERN OREGON REHABILITATION CENTER AND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TWISS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-826-2111
Mailing Address - Street 1:8495 CRATER LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-3011
Mailing Address - Country:US
Mailing Address - Phone:541-826-2111
Mailing Address - Fax:541-830-3518
Practice Address - Street 1:8495 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-3011
Practice Address - Country:US
Practice Address - Phone:541-826-2111
Practice Address - Fax:541-830-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility