Provider Demographics
NPI:1629127584
Name:UMATILLA COUNTY ALCOHOL & DRUG PROGRAM
Entity Type:Organization
Organization Name:UMATILLA COUNTY ALCOHOL & DRUG PROGRAM
Other - Org Name:UMATILLA COUNTY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:CR
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC
Authorized Official - Phone:541-278-6330
Mailing Address - Street 1:200 SE HAILEY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3073
Mailing Address - Country:US
Mailing Address - Phone:541-278-6330
Mailing Address - Fax:541-278-5419
Practice Address - Street 1:200 SE HAILEY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3073
Practice Address - Country:US
Practice Address - Phone:541-278-6330
Practice Address - Fax:541-278-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR184028Medicaid