Provider Demographics
NPI:1922162338
Name:LINCOLN COUNTY COUNCIL ON ALCOHOL & OTHER DRUG ABUSE, INC.
Entity Type:Organization
Organization Name:LINCOLN COUNTY COUNCIL ON ALCOHOL & OTHER DRUG ABUSE, INC.
Other - Org Name:THE KEN TRUEMAN RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-265-2971
Mailing Address - Street 1:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-0098
Mailing Address - Country:US
Mailing Address - Phone:541-265-2971
Mailing Address - Fax:541-265-6824
Practice Address - Street 1:351 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4963
Practice Address - Country:US
Practice Address - Phone:541-265-2971
Practice Address - Fax:541-265-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X, 261QM0850X, 261QR0405X, 276400000X, 324500000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Not Answered261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Not Answered276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Not Answered385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR090489OtherOREGON HEALTH PLAN