Provider Demographics
NPI:1467885145
Name:KLAMATH COUNTY JUVENILE DEPARTMENT
Entity Type:Organization
Organization Name:KLAMATH COUNTY JUVENILE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-851-3856
Mailing Address - Street 1:3331 VANDENBERG RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-3730
Mailing Address - Country:US
Mailing Address - Phone:541-851-3856
Mailing Address - Fax:541-885-6755
Practice Address - Street 1:3331 VANDENBERG RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3730
Practice Address - Country:US
Practice Address - Phone:541-851-3856
Practice Address - Fax:541-885-6755
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLAMATH COUNTY, OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children