Provider Demographics
NPI:1205075025
Name:SHARED HOPE FOR HEALING
Entity type:Organization
Organization Name:SHARED HOPE FOR HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-779-4786
Mailing Address - Street 1:PO BOX 5785
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-0785
Mailing Address - Country:US
Mailing Address - Phone:503-316-1970
Mailing Address - Fax:503-391-7422
Practice Address - Street 1:6750 MCCOY RD
Practice Address - Street 2:
Practice Address - City:RICKREALL
Practice Address - State:OR
Practice Address - Zip Code:97371-9717
Practice Address - Country:US
Practice Address - Phone:503-779-4786
Practice Address - Fax:503-391-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR02336251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health