Provider Demographics
NPI:1891935235
Name:COOS COUNTY OREGON
Entity Type:Organization
Organization Name:COOS COUNTY OREGON
Other - Org Name:COOS COUNTY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-756-2020
Mailing Address - Street 1:1975 MCPHERSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-3482
Mailing Address - Country:US
Mailing Address - Phone:541-756-2020
Mailing Address - Fax:541-756-8982
Practice Address - Street 1:1975 MCPHERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-3482
Practice Address - Country:US
Practice Address - Phone:541-756-2020
Practice Address - Fax:541-756-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500500169Medicaid