Provider Demographics
NPI:1720607070
Name:EASTERN OREGON RECOVERY AND MEDICAL LLC
Entity Type:Organization
Organization Name:EASTERN OREGON RECOVERY AND MEDICAL LLC
Other - Org Name:TAMARACK HEALTH CLINIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEL CURTO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-724-0934
Mailing Address - Street 1:2021 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-3417
Mailing Address - Country:US
Mailing Address - Phone:541-239-5261
Mailing Address - Fax:
Practice Address - Street 1:2021 COURT AVE
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-3417
Practice Address - Country:US
Practice Address - Phone:541-239-5261
Practice Address - Fax:541-239-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201408399NPPPOtherFNP LICENSE