Provider Demographics
NPI:1972758373
Name:PENDLETON HOUSE
Entity Type:Organization
Organization Name:PENDLETON HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-276-2246
Mailing Address - Street 1:2585 WESTGATE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-9613
Mailing Address - Country:US
Mailing Address - Phone:541-276-2246
Mailing Address - Fax:541-276-1989
Practice Address - Street 1:2585 WESTGATE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-9613
Practice Address - Country:US
Practice Address - Phone:541-276-2246
Practice Address - Fax:541-276-1989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHS,OFFICE OF FINANCIAL SERVICES,DIRECTOR'S OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness