Provider Demographics
NPI:1710498001
Name:SPRINGFIELD TREATMENT CENTER
Entity Type:Organization
Organization Name:SPRINGFIELD TREATMENT CENTER
Other - Org Name:SPRINGFIELD TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-653-8284
Mailing Address - Street 1:1485 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3337
Mailing Address - Country:US
Mailing Address - Phone:541-653-8284
Mailing Address - Fax:
Practice Address - Street 1:1485 MARKET ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3337
Practice Address - Country:US
Practice Address - Phone:541-653-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-13
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRO0507650101YA0400X
261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR38D2134656Medicaid