Provider Demographics
NPI:1881346500
Name:ROGUE RETREAT
Entity type:Organization
Organization Name:ROGUE RETREAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPPORTIVE SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:HASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:THW
Authorized Official - Phone:541-499-0880
Mailing Address - Street 1:711 E MAIN ST STE 25
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7139
Mailing Address - Country:US
Mailing Address - Phone:541-499-0880
Mailing Address - Fax:541-690-1670
Practice Address - Street 1:711 E MAIN ST STE 25
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7139
Practice Address - Country:US
Practice Address - Phone:541-499-0880
Practice Address - Fax:541-690-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable