Provider Demographics
NPI:1720023807
Name:DEPT. OF HUMAN SRVCS/OFFICE OF FIN. SRVCS DBA: IRS/EOPC/EOTC/OSH/OSH-P
Entity Type:Organization
Organization Name:DEPT. OF HUMAN SRVCS/OFFICE OF FIN. SRVCS DBA: IRS/EOPC/EOTC/OSH/OSH-P
Other - Org Name:EASTERN OREGON TRAINING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSTITUTIONAL REVENUE SECTION MGR.
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KITTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-945-9440
Mailing Address - Street 1:PO BOX 14900
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-5016
Mailing Address - Country:US
Mailing Address - Phone:503-945-9469
Mailing Address - Fax:503-947-1007
Practice Address - Street 1:2525 WESTGATE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9613
Practice Address - Country:US
Practice Address - Phone:541-276-0820
Practice Address - Fax:541-276-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6021320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR400093Medicaid