Provider Demographics
NPI:1881685097
Name:ONTRACK, INC.
Entity Type:Organization
Organization Name:ONTRACK, INC.
Other - Org Name:ONTRACK ROGUE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-200-2414
Mailing Address - Street 1:300 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-772-1777
Mailing Address - Fax:541-724-2410
Practice Address - Street 1:300 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-772-1777
Practice Address - Fax:541-724-2410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONTRACK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-04
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL3421101YA0400X, 1041C0700X
ORL1777101YA0400X, 1041C0700X
OR131998103TC1900X, 103TC1900X
ORT0056106H00000X
251S00000X
OR193813324500000X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR020740000OtherBLUE CROSS/SHIELD
ORH2152-01OtherPACIFICSOURCE
OR193813Medicaid
OR117388OtherMHN
OR131998Medicare ID - Type Unspecified
ORH2152-01OtherPACIFICSOURCE
ORY38502Medicare UPIN
OR132000Medicare ID - Type Unspecified
OR117388OtherMHN