Provider Demographics
NPI:1558029447
Name:BROOKINGS COMMUNITY RESOURCE RESPONSE
Entity Type:Organization
Organization Name:BROOKINGS COMMUNITY RESOURCE RESPONSE
Other - Org Name:BROOKINGS CORE RESPONSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:CHW
Authorized Official - Phone:541-251-0825
Mailing Address - Street 1:PO BOX 4160
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0058
Mailing Address - Country:US
Mailing Address - Phone:541-251-0825
Mailing Address - Fax:
Practice Address - Street 1:97900 SHOPPING CENTER AVE # 31
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9412
Practice Address - Country:US
Practice Address - Phone:541-251-0825
Practice Address - Fax:541-813-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty