Provider Demographics
NPI:1861863409
Name:KLAMATH CHILD AND FAMILY TREATMENT CENTER
Entity Type:Organization
Organization Name:KLAMATH CHILD AND FAMILY TREATMENT CENTER
Other - Org Name:KLAMATH BASIN BEHAVIOR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RESIDENT CARE AID
Authorized Official - Prefix:
Authorized Official - First Name:KARENA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-892-4655
Mailing Address - Street 1:13907 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-9591
Mailing Address - Country:US
Mailing Address - Phone:541-892-4655
Mailing Address - Fax:
Practice Address - Street 1:2210 N ELDORADO AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6418
Practice Address - Country:US
Practice Address - Phone:541-883-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR93-0753926251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health