Provider Demographics
NPI:1295051126
Name:PROJECT DOVE
Entity type:Organization
Organization Name:PROJECT DOVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF BOARD OF DIRECTORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLACKABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-889-8693
Mailing Address - Street 1:585 NW 1ST ST
Mailing Address - Street 2:P O BOX 980
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1701
Mailing Address - Country:US
Mailing Address - Phone:541-889-6316
Mailing Address - Fax:541-889-2416
Practice Address - Street 1:915-02 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-881-0153
Practice Address - Fax:541-889-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288071Medicare PIN
ID806085800Medicare PIN