Provider Demographics
NPI:1598301251
Name:BANDON COMMUNITY HEALTH CTR
Entity Type:Organization
Organization Name:BANDON COMMUNITY HEALTH CTR
Other - Org Name:AUBORN CENTER FOR WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-347-2529
Mailing Address - Street 1:1010 1ST ST SE STE 110
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-9301
Mailing Address - Country:US
Mailing Address - Phone:541-347-2529
Mailing Address - Fax:
Practice Address - Street 1:716 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465-8672
Practice Address - Country:US
Practice Address - Phone:541-347-2529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BANDON COMMUNITY HEALTH CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-18
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)