Provider Demographics
NPI:1629270780
Name:HOMESTEAD YOUTH & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:HOMESTEAD YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERICAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CREGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-276-5433
Mailing Address - Street 1:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0260
Mailing Address - Country:US
Mailing Address - Phone:541-276-5433
Mailing Address - Fax:541-276-8605
Practice Address - Street 1:816 SE 15TH ST.
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-276-5433
Practice Address - Fax:541-276-8605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR127187853245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240007Medicaid