Provider Demographics
NPI:1295280451
Name:GRANTS PASS TREATMENT CENTER
Entity type:Organization
Organization Name:GRANTS PASS TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-617-4544
Mailing Address - Street 1:1885 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3403
Mailing Address - Country:US
Mailing Address - Phone:936-524-2837
Mailing Address - Fax:
Practice Address - Street 1:155 NE REVERE AVE
Practice Address - Street 2:STE 150
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4147
Practice Address - Country:US
Practice Address - Phone:936-524-2837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone