Provider Demographics
NPI:1750462230
Name:PREVENTION AND RECOVERY NORTHWEST
Entity Type:Organization
Organization Name:PREVENTION AND RECOVERY NORTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILDERBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-484-9274
Mailing Address - Street 1:1188 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3547
Mailing Address - Country:US
Mailing Address - Phone:541-484-9274
Mailing Address - Fax:541-484-5021
Practice Address - Street 1:1188 OLIVE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3547
Practice Address - Country:US
Practice Address - Phone:541-484-9274
Practice Address - Fax:541-484-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR165165Medicaid