Provider Demographics
NPI:1740324953
Name:EASTERN OREGON ALCOHOLISM FOUNDATION
Entity type:Organization
Organization Name:EASTERN OREGON ALCOHOLISM FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:DUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:CADCII, QMHP
Authorized Official - Phone:541-276-3518
Mailing Address - Street 1:216 S.W. HAILEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-276-3518
Mailing Address - Fax:541-276-4189
Practice Address - Street 1:216 SW HAILEY AVENUE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-276-3518
Practice Address - Fax:541-276-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251B00000X, 251S00000X, 324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006405Medicaid