Provider Demographics
NPI:1750512661
Name:CHEHALEM YOUTH & FAMILY SERVICES
Entity type:Organization
Organization Name:CHEHALEM YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGERICH
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:503-538-4874
Mailing Address - Street 1:504 VILLA RD STE 3
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1851
Mailing Address - Country:US
Mailing Address - Phone:503-538-4874
Mailing Address - Fax:503-538-1271
Practice Address - Street 1:504 VILLA RD STE 3
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1851
Practice Address - Country:US
Practice Address - Phone:503-538-4874
Practice Address - Fax:503-538-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORNA FOR THIS TYPE261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)