Provider Demographics
NPI:1134883887
Name:REVEILLE FOUNDATION
Entity type:Organization
Organization Name:REVEILLE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:YAMAMORI
Authorized Official - Suffix:
Authorized Official - Credentials:MED, QMHA-R
Authorized Official - Phone:602-369-3531
Mailing Address - Street 1:1711 WILLAMETTE STREET
Mailing Address - Street 2:SUITE 301, #779
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1914
Mailing Address - Country:US
Mailing Address - Phone:602-369-3531
Mailing Address - Fax:
Practice Address - Street 1:1190 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4610
Practice Address - Country:US
Practice Address - Phone:602-369-3531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management