Provider Demographics
NPI:1730636762
Name:WILLAMETTE VALLEY TREATMENT CENTER
Entity Type:Organization
Organization Name:WILLAMETTE VALLEY TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOBAIL
Authorized Official - Middle Name:NAVIDA
Authorized Official - Last Name:LABILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-974-1010
Mailing Address - Street 1:3513 SILVERPARK PL NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2012
Mailing Address - Country:US
Mailing Address - Phone:541-974-1010
Mailing Address - Fax:
Practice Address - Street 1:3871 FAIRVIEW INDUSTRIAL DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1180
Practice Address - Country:US
Practice Address - Phone:503-391-9762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201601769LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty