Provider Demographics
NPI: | 1669000865 |
---|---|
Name: | MID-VALLEY HEALTHCARE, INC. |
Entity Type: | Organization |
Organization Name: | MID-VALLEY HEALTHCARE, INC. |
Other - Org Name: | SAMARITAN TREATMENT & RECOVERY SERVICES (RESIDENTIAL) |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | CAHILL |
Authorized Official - Suffix: | III |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 541-602-4907 |
Mailing Address - Street 1: | PO BOX 1193 |
Mailing Address - Street 2: | |
Mailing Address - City: | CORVALLIS |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97339-1193 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 111 N MAIN ST STE B |
Practice Address - Street 2: | |
Practice Address - City: | LEBANON |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97355-2869 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-451-6388 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MID VALLEY HEALTHCARE INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2020-04-01 |
Last Update Date: | 2020-06-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |