Provider Demographics
NPI:1578864641
Name:KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Entity Type:Organization
Organization Name:KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Other - Org Name:KLAMATH YOUTH REGIONAL TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:541-882-1487
Mailing Address - Street 1:3949 SOUTH 6TH ST.
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4746
Mailing Address - Country:US
Mailing Address - Phone:541-882-1487
Mailing Address - Fax:541-882-1670
Practice Address - Street 1:121 IOWA ST.
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-882-1487
Practice Address - Fax:541-882-1670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLAMATH TRIBAL HEALTH & FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children