Provider Demographics
NPI:1689162976
Name:CORVALLIS HOMELESS SHELTER COALITION
Entity Type:Organization
Organization Name:CORVALLIS HOMELESS SHELTER COALITION
Other - Org Name:CORVALLIS HOUSING FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MYHRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-602-8502
Mailing Address - Street 1:2311 NW VAN BUREN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5393
Mailing Address - Country:US
Mailing Address - Phone:541-230-1297
Mailing Address - Fax:541-368-3902
Practice Address - Street 1:2311 NW VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5399
Practice Address - Country:US
Practice Address - Phone:541-230-1297
Practice Address - Fax:541-368-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR435001-98Medicaid