Provider Demographics
NPI:1689053688
Name:LANE COUNTY TREATMENT CENTER
Entity Type:Organization
Organization Name:LANE COUNTY TREATMENT CENTER
Other - Org Name:LANE COUNTY METHADONE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING COORD
Authorized Official - Phone:541-682-7987
Mailing Address - Street 1:2073 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3413
Mailing Address - Country:US
Mailing Address - Phone:541-682-4464
Mailing Address - Fax:541-682-3967
Practice Address - Street 1:432 W 11TH AVE RM 170
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3451
Practice Address - Country:US
Practice Address - Phone:541-682-4464
Practice Address - Fax:541-682-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200141240RN163WC1500X
261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder