Provider Demographics
NPI:1013952829
Name:OLALLA CENTER
Entity Type:Organization
Organization Name:OLALLA CENTER
Other - Org Name:LINCOLN COUNTY CHILD DAY TREATMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:SIERRA
Authorized Official - Last Name:MCKNIGHT-TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-336-2254
Mailing Address - Street 1:321 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OR
Mailing Address - Zip Code:97391-1613
Mailing Address - Country:US
Mailing Address - Phone:541-336-2254
Mailing Address - Fax:541-336-1803
Practice Address - Street 1:321 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-1613
Practice Address - Country:US
Practice Address - Phone:541-336-2254
Practice Address - Fax:541-336-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR106261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297880OtherOMAP