Provider Demographics
NPI:1508272261
Name:JOSEPHINE COUNTY COMMUNITY CORRECTIONS
Entity Type:Organization
Organization Name:JOSEPHINE COUNTY COMMUNITY CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC II
Authorized Official - Phone:541-474-5191
Mailing Address - Street 1:510 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2078
Mailing Address - Country:US
Mailing Address - Phone:541-474-5191
Mailing Address - Fax:
Practice Address - Street 1:510 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-2078
Practice Address - Country:US
Practice Address - Phone:541-474-5191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty