Provider Demographics
NPI:1336889211
Name:ELDERLY AND DISABLED SERVICES
Entity Type:Organization
Organization Name:ELDERLY AND DISABLED SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-261-1991
Mailing Address - Street 1:4439 HAMRICK RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2816
Mailing Address - Country:US
Mailing Address - Phone:541-261-1991
Mailing Address - Fax:541-631-3424
Practice Address - Street 1:4439 HAMRICK RD
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2816
Practice Address - Country:US
Practice Address - Phone:541-261-1991
Practice Address - Fax:541-631-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500788139Medicaid
OR500791695Medicaid