Provider Demographics
NPI:1265866305
Name:HILLCREST YOUTH CORRECTIONAL FACILITY-OREGON YOUTH AUTHORITY
Entity type:Organization
Organization Name:HILLCREST YOUTH CORRECTIONAL FACILITY-OREGON YOUTH AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-986-0361
Mailing Address - Street 1:2450 STRONG RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-9676
Mailing Address - Country:US
Mailing Address - Phone:503-986-0432
Mailing Address - Fax:
Practice Address - Street 1:2450 STRONG RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-9676
Practice Address - Country:US
Practice Address - Phone:503-986-0432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OREGON YOUTH AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7000353245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children