Provider Demographics
NPI:1871245183
Name:LGS OPERATING COMPANY
Entity Type:Organization
Organization Name:LGS OPERATING COMPANY
Other - Org Name:LIVE. SHARE. GROW. LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-525-3139
Mailing Address - Street 1:87750 CHARLET DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-9151
Mailing Address - Country:US
Mailing Address - Phone:541-525-3139
Mailing Address - Fax:
Practice Address - Street 1:315 COBURG RD STE C
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6114
Practice Address - Country:US
Practice Address - Phone:541-505-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness