Provider Demographics
NPI:1801012695
Name:COMMUNITY REHABILITATION SERVICES OF OREGON
Entity Type:Organization
Organization Name:COMMUNITY REHABILITATION SERVICES OF OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:541-342-1980
Mailing Address - Street 1:1501 PEARL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4606
Mailing Address - Country:US
Mailing Address - Phone:541-342-1980
Mailing Address - Fax:541-342-6207
Practice Address - Street 1:1501 PEARL ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4606
Practice Address - Country:US
Practice Address - Phone:541-342-1980
Practice Address - Fax:541-342-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty